Left gastric artery pseudoaneurysm: a rare presentation of delayed bleeding after peroral endoscopic myotomy for achalasia cardia

Abstract

A 22-year-old with type I achalasia cardia underwent peroral endoscopic myotomy (POEM) by use of an anterior approach at our center. The patient had an episode of hematemesis 48 hours after the procedure, along with a drop in hemoglobin of 3.5 g/dL. Urgent upper GI endoscopy showed a large submucosal bulge in the esophagus extending into the stomach along the lesser curvature, suggestive of submucosal hematoma (A). CT angiography showed a large submucosal hematoma with a pseudoaneurysm arising from a branch of the left gastric artery (B, white arrow) in relation to the left gastric artery (B, yellow arrow).