Epigastric Pain With Falling Hematocrit

Abstract

History A 56-year-old woman was admitted with severe epigastric pain after having eaten a large meal. The patient was diaphoretic and had tachycardia. The pain radiated across the abdomen and was suggestive of biliary colic. The blood pressure was 110/70 mm Hg, with a regular pulse rate of 144 beats per minute. The hematocrit value was 34.3%, and the hemoglobin concentration was 12 g/dL. The initial diagnosis was cholecystitis, cholelithiasis, and gallbladder colic. An intravenous cholangiogram was normal. The hematocrit value fell to 25.7%, and the hemoglobin concentration fell to 8.8 g/dL in 24 hours, with a blood pressure of 70/40 mm Hg. There was no evidence of bleeding from the gastrointestinal tract. An emergency angiogram was performed (Fig 1 and 2). Diagnosis Aneurysm of the inferior pancreaticoduodenal artery with retroperitoneal bleeding. Subtraction film of the early arterial phase of the superior mesenteric angiogram (Fig 1) shows a 2-cm aneurysm