POST CYSTOGASTROSTOMY BLEEDING-COMMON COMPLICATION UNUSUAL CAUSE: A CASE REPORT

Abstract

Pseudoaneurysms of gastroduodenal artery are rare and mostly associated with pancreatitis. We report a case of a ruptured GDA aneurysm in a patient who underwent cystogastrostomy for pancreatic pseudocyst and this has rarely been reported in the literature. Our patient presented with hematemesis 2 week postoperatively. CT angiogram showed pseudoaneurysm of the GDA and which was embolised. Our case highlights that GDA aneurysm must be considered in the differential for a patient who presents with upper GI tract bleed after drainage of pancreatic pseudocyst and that it can be managed with angioembolization. A 30 year old male presented to our surgery department with a four-month history of pain & swelling over upper abdomen with associated vomiting. CT scan showed large thicked walled cystic lesion in lesser sac abutting the uncinate process with atrophy of body and tail of pancrease s/o chronic pancreatitis with pseudocyst formation. We performed cystogastrostomy for pancreatic pseudocyst. Two week later, he presented with the complains of hematemesis. Patient was resuscitated initially and then CT angiogram was planned that showed pseudoaneurysm of the GDA. The pseudoaneurysm was embolised and patient was sent home later on. Gastroduodenal artery aneurysm shoud be suspected in a patient with GI hemorrhage after surgery for Pancreatic pseudocyst. The investigation of choice is CT angiography and endovascular angioembolisation is the treatment modality of choice.