Gastroduodenal Artery Aneurysm Presenting as Jaundice and Abdominal Pain

Abstract

Visceral artery aneurysm is a very rare and potentially serious vascular anomaly. The mortality rate from bleeding is 40–60%. Aneurysms of the gastroduodenal artery rank among the rarest splanchnic artery aneurysms, comprising fewer than 2 per cent of all such lesions. We report a case of a 41 year old male with history of pancreatitis admitted with jaundice and vague right upper quadrant pain. Laboratory findings suggested a cholestatic picture and ultrasound of the abdomen revealed a mass of the head of the pancreas causing compression of the common bile duct. Further imaging with a CT scan revealed a 5.6 cm aneurysm of the gastroduodenal artery with surrounding hematoma. Mesenteric angiogram showed aneurysm arising from the proximal gastroduodenal artery and occlusion of the celiac axis with multiple collaterals from superior mesenteric artery to the hepatic and splenic arteries. Coil embolisation could result in hepatic ischemia in the setting of celiac axis occlusion, and was not attempted. Patient underwent ERCP and stenting of the common bile duct with successful decompression of the biliary system. Operative exploration with intraoperative visceral angiogram showed celiac axis compression within the medial arcuate ligament of the diaphragm. The medial arcuate ligament was divided leading to restoration of blood flow to the liver. The inflow and outflow vessels of the aneurysms were ligated without the risk of hepatic ischemia. Patient recovered uneventfully. This case illustrates an uncommon cause of obstructive jaundice caused by bleeding aneurysm of the gastroduodenal artery in the settings of prior pancreatitis and celiac axis occlusion.