Gastroduodenal Artery Aneurysm: A Gastrointestinal Challenge

Abstract

Purpose: Gastroduodenal artery (GDA) aneurysm is a rare and challenging entity. Patients can present asymptomatic or with a variety of symptoms. Timely diagnosis, localization, and surgical or endovascular intervention is necessary to avoid devastating consequences. We describe an incident of a GDA aneurysm and review the current literature on the topic. Case: A 63-year-old man with hyperlipidemia and G6PD deficiency was sent by his PCP for a renal sonogram to evaluate a known history of renal cysts. Renal sonogram showed minimal internal complexity which had not been seen 5 years prior. A CT abdomen was ordered and showed a suspected GDA aneurysm measuring 2.9 × 2.9 cm. The GI service was asked about any further studies and a CT angiogram was performed showing a stable aneurysm arising from the GDA measuring 2.8 × 3.2 cm. A celiac angiogram confirmed the GDA aneurysm and the patient was referred for endovascular therapy. Discussion: The true incidence of GDA aneurysm is reported to be around 0.5-1.5% but is difficult to determine because many are asymptomatic. Mean age is in the sixth decade with a male predominance. Mean size is 3.6 cm. Presentation ranges from a palpable epigastric mass to gastric outlet obstruction to diarrhea. Risk factors include hypertension, atherosclerosis, trauma, and prior vessel instrumentation. Symptomatic aneurysms and those in high-risk patients warrant attention because of the high morbidity and mortality (˜21%) associated with rupture. Rupture is not determined by the size of the GDA aneurysm. Definitive treatment should be performed once diagnosis is made. CT and US (˜67% and 50% sensitive) are the best noninvasive tests. Angiography, which is more invasive but allows for diagnostic and therapeutic purposes, is most sensitive (100%). GDA aneurysms can be treated by revascularization, surgical ligation, or endovascular techniques. Endoscopic techniques may help identify or stop the source of a bleed initially but if they fail then management would be with either endovascular or surgical techniques. Although GDA aneurysm has been reported in surgical literature there are scarce reports in the GI literature. This case illustrates an “incidenteloma” of imaging and how a gastroenterologist's early and aggressive approach can prevent disaster.Figure: CT/Angio GDA aneurysm.