A Common Hepatic Artery Aneurysm Mimicking A Duodenal Submucosal Tumor Presenting as Upper Gastrointestinal Bleeding: A Case Report

Abstract

Hepatic artery aneurysm is an uncommon etiology of upper gastrointestinal bleeding. It can present as a duodenal submucosal tumor-like lesion due to extrinsic compression during endoscopic examination. Such aneurismal bleeding usually has abrupt onset and high risk of rebleeding. Hence, rapid diagnosis and early intervention is necessary. We presented a middle-aged man suffering from upper gastrointestinal bleeding due to a common hepatic artery aneurysm mimicking a duodenal submucosal tumor. After endoscopic hemostasis with hemoclip, the following computed tomography (CT) scan of abdomen showed a ruptured common hepatic artery aneurysm abutting the duodenal bulb. Recurrent gastrointestinal bleeding with hypovolemic shock complicated on the next day. This patient subsequently underwent surgical repair of aneurysm of common hepatic artery and recovered smoothly. No more recurrent bleeding was noted during six months' follow-up. In summary, vascular aneurismal lesion should be included in the differential diagnosis of a duodenal submucosal tumor-like lesion. Then, hemoclipping is a better and safer technique for temporal hemostasis to a suspected vascular lesion. Finally, further work-up like CT must be obtained as soon as possible for clarifying the submucosal tumor-like lesion and guiding further management. Surgical or radiological intervention is definite for aneurismal rupture-related gastrointestinal hemorrhage.