S2684 A Rare Case of Helicobacter pylori Gastric Ulcer Causing Left Gastric Artery Pseudoaneurysm and Upper GI Bleed: A Case Report and Scoping Review of Human Cases

Abstract

Introduction: Pseudoaneurysm is an uncommon but lethal presentation of upper gastrointestinal hemorrhage, as a rupture is associated with a 40-80% mortality rate. Here, we report a rare case of left gastric artery pseudoaneurysm secondary to Helicobacter pylori (HP) infection-associated peptic ulcer disease presenting as upper gastrointestinal hemorrhage. Case Description/Methods: A 62-year-old male with a history of oral cancer status post resection in 2015, polysubstance use disorder (cocaine, heroin, and methamphetamine), hypertension, and gastroesophageal reflux disease presented to the hospital with chest and epigastric pain and melena. Admission laboratory findings were notable for acute kidney injury, leukocytosis, and normocytic anemia. Computed tomography angiography (CT-A) demonstrated a small pseudoaneurysm arising from the left gastric artery projecting into the stomach wall, heterogeneous material within the stomach, and a prominent left gastric artery. These findings were concerning for intraluminal hemorrhage (Figure). The patient underwent emergent embolization of the left gastric artery pseudoaneurysm, followed by esophagogastroduodenoscopy (EGD). This revealed a 2.5 cm ulceration over the lesser curvature of the stomach, and biopsies were positive for HP infection. A systematic review in PubMed and Embase for gastric artery pseudoaneurysm due to gastric ulcer only resulted in one other case report. Though also rare, splenic artery pseudoaneurysm due to gastric ulceration is more common, as our search yielded 5 case reports. Discussion: Acute upper gastrointestinal bleeds presenting to the emergency department are most commonly secondary to variceal hemorrhage or peptic ulcer disease. Peptic ulcer disease can result in gastric artery pseudoaneurysm, however as we only found only one other case report documenting this presentation, it appears to be extremely rare. Recognition of gastric pseudoaneurysm on the CT-A should prompt endoscopic exploration and biopsy with HP testing, with close follow-up for a test of cure.Figure 1.: Computed tomography angiography. (a) Sagittal plane, (b) Transverse plane.