Gastroduodenal Artery Aneurysm Research Articles

Stenting of gastroduodenal artery pseudoaneurysm threatened rupture: report of a case

Gastroduodenal artery (GDA) aneurysm is a rare surgical entity that causes various symptoms. In the case of rupture, it usually presents an ominous prognosis and mortality rate of up to 40%. Although open surgical procedure is a mainstay, endovascular intervention is emerging as a promising treatment in recent years, due to its advantages and safety. We present a case of upper gastrointestinal bleeding caused by GDA pseudoaneurysm threatened rupture in a 72-year-old woman, with medical episodes of acute pancreatitis, a pancreatic body tumor removal surgery was performed, and now the tumor is relapsing and metastasizing. The treatment approach is blocking off the pseudoaneurysm by a covered stent. The procedure was successful and the patient is asymptomatic. Two months later, the pseudoaneurysm reduces its size and is completely excluded from the preservation of the blood flow in the artery. Endovascular interventional treatment in the case of GDA aneurysms is considered a promising alternative not only to open surgery but also to an effective emerging technique even in the acute setting.

Management of True Gastroduodenal Artery Aneurysm: A Case Report and Literature Review

Abstract Gastroduodenal artery (GDA) aneurysms are rare forms of splanchnic artery aneurysms with varied etiopathogenesis. Mostly found incidentally, early identification with advanced imaging tools and timely intervention of these aneurysms are essential due to the associated high risk of rupture, morbidity, and mortality with GDA aneurysms. We report a case of successfully treated GDA aneurysm using endovascular coil embolization.

Coil Embolization of Isolated Gastroduodenal Artery Pseudoaneurysm

Abstract Gastroduodenal artery (GDA) aneurysm is very rare, and it comprises around 1.5% of all visceral artery aneurysms. More common in male (male:female = 4:1) patients attributed to increased alcoholism and incidence of pancreatitis. In this case report, we describe a successful coil embolization of GDA pseudoaneurysm.

Clinical Characteristics and Management of Peripancreatic Arterial Aneurysms: A 20-year Experience.

Pancreaticoduodenal and gastroduodenal artery aneurysms (PDAAs and GDAAs) are rare visceral aneurysms. Considering the rupture risk regardless of size, treatment should be provided promptly. We reviewed the characteristics and management of peripancreatic aneurysms in a retrospective, single-center review of consecutive patients with PDAAs and GDAAs between 2000 and 2022. Demographics, clinical characteristics, radiologic features, treatment, and outcomes were recorded. Nineteen PDAAs and seven GDAAs were identified in 24 patients. The median sizes of the PDAAs and GDAAs were 21mm (range: 8-50mm) and 14mm (range: 11-32mm), respectively. There were 4 ruptured cases (15.4%). Ten aneurysms (38.5%) had concomitant visceral aneurysms, and 16 (61.6%) were associated with celiac pathology. Aneurysms were managed using endovascular in 12 (46.2%), surgical in 4 (15.4%), and combined methods in 3 (11.5%) cases; 7 patients (26.9%) were lost to follow-up or refused treatments. During a median 13.8-month follow-up (range: 1-147.6), two complications (7.7%) occurred including pancreatitis and coil migration into the superior mesenteric artery after embolization within 30 days. After 30 days, aorto-common hepatic artery bypass graft stenosis was identified in one PDAA. Depending on the characteristics of peripancreatic aneurysms, endovascular, surgical, and hybrid approaches might all be practical treatment options.

A gastroduodenal artery aneurysm with superior mesenteric artery occlusion repaired by incomplete aneurysmectomy for mesenteric collateral vasculature protection

A gastroduodenal artery aneurysm with superior mesenteric artery occlusion repaired by incomplete aneurysmectomy for mesenteric collateral vasculature protection

Surgical repair of ruptured gastroduodenal artery aneurysm caused by duodenal ulcer: A case report

Surgical repair of ruptured gastroduodenal artery aneurysm caused by duodenal ulcer: A case report

Systematic hybrid laparoscopic and endovascular treatment of median arcuate ligament syndrome: A single-center experience.

Median arcuate ligament syndrome (MALS) is caused by celiac trunk (CT) compression by the median arcuate ligament. Clinically, this pathology varies from postprandial pain (Dunbar syndrome) to a life-threatening hemorrhage because of a rupture of a gastroduodenal artery aneurysm (GAA). Due to the low prevalence of this disease, there is no standard management for MALS. This was a single-center, retrospective study of 13 patients. Two groups were identified on the basis of the initial clinical presentation: those operated for a GAA rupture (bleeding group-BG) and those operated electively for Dunbar syndrome (Dunbar syndrome group-DG). The primary endpoint was 30-day postoperative complications of a systematic laparoscopic release of the median arcuate ligament and stenting during the same procedure. Seven patients (54%) underwent elective surgery. Six patients (46%) underwent semiurgent repair under elective conditions post-embolization for GAA bleeding. The total operative time was longer in the BG (p = 0.06). Two patients in the BG suffered early major complications and needed reintervention, and those in the DG had a lower comprehensive complication index. No mortality was reported at 30 days. Overall median length of stay was 5 days (IQR: 3.5-15.3). Patients in the DG had a significantly shorter length of stay (p = 0.02). At 6 months, the primary and secondary CT stent patencies were 82% and 100%, respectively. There were no high-flow GAA recurrences. A combined approach of laparoscopic release of the median arcuate ligament and stenting during the same procedure is feasible and safe, and this approach must be systematically discussed in symptomatic patients.

Gastro-Duodenal Artery Aneurysm Rupture – Case Report

Background The definition of an aneurysm is a dilation of an artery more than 1.5 to 2 times its normal diameter. Visceral (or splanchnic) artery aneurysms include those concerning the celiac truncus, superior mesenteric artery, inferior mesenteric artery, and their branches. This classification does not include aortic and renal artery aneurysms. It is a rare, but clinically significant pathology because of the high mortality risk. Despite this rarity, cases have been accumulated and this pathology is better understood. Novel techniques for the management of aneurysms have been developed with the advent of interventional radiology. However, our case concerns the emergent surgical repair of a ruptured aneurysm, rather than the elective repair. Case presentation The 61-year-old female patient complains of diffuse, intermittent abdominal pain lasting for almost one week. On the last day the patient suffers from excruciating abdominal pain and is brought to the emergency department. Objective evaluation shows pallor, diaphoresis, low blood pressure, tachycardia and abdominal guarding in all quadrants. An abdominal ultrasound spots the presence of free fluid in all recesses. A diagnostic peritoneal needle aspiration shows pure blood. AB0 and Rhesus blood type is identified and the patient is prepared for the operating theatre. Following a laparotomy, peritoneal lavage, a rupture of gastro-duodenal aneurysm is identified and the artery is ligated in its origin. The patient tolerated the procedure well and was discharged in good health. Discussion Rare case reports in literature have reported Gastro-duodenal artery aneurysms. Because of this rarity in incidence there is no clear protocol on how to diagnose and manage it. Possible risk factors and associated conditions include: chronic pancreatitis, liver cirrhosis, vascular abnormalities as fibromuscular dysplasia and polyarteritis nodosa. Other events and diseases such as trauma, septic emboli, hypertension and atherosclerosis are also mentioned. The main symptoms of visceral artery aneurysms, with or without rupture are abdominal pain, hypotension, gastric emptying delay and other non-specific manifestations such as vomiting, diarrhoea, jaundice, upper gastro-intestinal tract haemorrhage (which occurs in about 50% of the cases with gastro-duodenal artery aneurysms) and retro and intra-peritoneal bleeding. Conclusion The rupture of gastro-duodenal artery is a serious fatal presentation of a rare condition. It requires high alertness and decisive action, as warning signs and symptoms may be dull or absent. Quick diagnosis before rupture can change the course of this disease and prevent lethal complications. As this disorder is so uncommon, there are no specific screening or follow-up recommendations. Treatment and diagnostic options should be decided on a case basis. Keywords: General Surgery, Visceral Artery Aneurysm, VAA, Splanchnic Aneurysm, Aneurysm Rupture. DOI: 10.7176/JEP/14-8-02 Publication date: March 31 st 2023

Gastroduodenal artery aneurysm presenting as gastric outlet obstruction.

A 30-year-old female with a history of acute biliary pancreatitis two months ago, presented with a four-week history of recurrent vomiting, occurring one to two hours after meals. The patientunderwent an endoscopy, showing a 3 cm mass arising from the posterior wall of the duodenal bulb impinging the pyloric opening (Fig. 1A), with overlying normal mucosa. In view of a suspected subepithelial lesion, an endoscopic ultrasound was performed, showing a 3.2 × 2.6 cm aneurysm (Long arrow, Fig. 1B) arising from the gastroduodenal artery (GDA) (Short arrow, Fig. 1B).

S2599 Gastroduodenal Artery Aneurysm: When Endoscopy Is Not the Answer

Introduction: Gastroduodenal artery aneurysms (GDAAs) are rare with high mortality rate. We present a patient with massive gastrointestinal (GI) bleeding found to have gastroduodenal artery pseudoaneurysm. Case Description/Methods: A 75-year-old woman with hypertension, diabetes, sleep apnea, and prior stroke presented with fatigue, nausea, and decreased appetite. Vital signs and physical exam were normal. Hemoglobin (Hgb) was 13.2 grams per deciliter (g/dl). Nine days later, she developed abdominal pain and melena. Vital signs and physical exam were normal, Hgb was 11.8 g/dl, and computed tomography angiography (CTA) was normal. Esophagogastroduodenoscopy (EGD) showed duodenal ulcer with visible vessel, treated with epinephrine injection (epi) and hemoclips. Melena recurred eleven days later. Repeat EGD showed duodenal bleeding with poor visibility, prompting transfer to our hospital. EGD at our facility showed hemi-circumferential deep ulcer and arterial spurting in the distal duodenal bulb, treated with epi and hemoclips resulting in initial hemostasis but then continued bleeding (Figure 1A). She developed pulseless electrical activity arrest but was resuscitated. Mesenteric angiogram showed a 0.8 × 0.8 centimeter distal gastroduodenal artery pseudoaneurysm with extravasation requiring embolization with 2-4 millimeter interlock coils (Figure 1B). There was no further bleeding and she was discharged. Discussion: GDAAs account for 1.5% of visceral arterial aneurysms, which include true aneurysms and pseudoaneurysms (PAs). True aneurysms arise from vessel wall abnormalities such as degenerative or atherosclerotic processes, fibromuscular dysplasia, or collagen vascular diseases. PAs arise from vascular insults such as trauma, iatrogenic injury, or inflammation. The risk of GDAA PA rupture is as high as 75%. GDAAs may be asymptomatic or present as GI bleeding, abdominal pain, gastric outlet obstruction, or a pulsatile abdominal mass. CTA is the initial imaging of choice given high sensitivity, availability, and promptness. Mesenteric angiography is the diagnostic gold standard and allows for therapeutic intervention with endovascular embolization, which has superior outcomes compared to open surgical ligation. Follow-up imaging is necessary to look for aneurysm reperfusion, seen in 9-15% of cases. GDAA rupture is a difficult yet crucial diagnosis to make given mortality rate up to 21%.Figure 1.: A, Duodenal ulcer with actively spurting visible vessel. B, Mesenteric angiogram shows gastroduodenal artery pseudoaneurysm with extravasation of contrast (black arrow).

Volumetric computed tomography analysis for gastroduodenal and pancreaticoduodenal artery aneurysm formation: A retrospective single-center study.

Gastroduodenal artery aneurysms (GDAA) and pancreaticoduodenal artery aneurysms (PDAA) are rare, have high rupture risks, and are located in the arcade between the celiac artery and the superior mesenteric artery. Pancreaticoduodenal artery aneurysms are associated with celiac artery stenosis, and it is hypothesized that these celiac lesions might contribute to the formation of aneurysms. In contrast, a few studies have reported an association between a gastroduodenal artery aneurysm and celiac lesions. This study aimed to investigate the potential differences between patients with gastroduodenal and pancreaticoduodenal artery aneurysms and better understand their pathogenesis.We selected patients with GDAA and PDAA who were admitted to our department between January 2010 and December 2020. Aortic wall volume, aortic wall calcification, and pancreaticoduodenal arcade volume of computed tomography images were calculated semi-manually using Horos 3.3.5.Eight GDAAs and 11 PDAAs were analyzed. Celiac lesions were found in all PDAA patients, with none in GDAA cases. Volumetry demonstrated that aortic wall volume and calcification were more prominent in the GDAA group than in the PDAA group (P = .026 and P = .049, respectively). The pancreaticoduodenal arcade volume was larger in the PDAA group (P = .002).In our study, celiac artery lesions were strongly correlated with PDAA. The volume of the pancreaticoduodenal arcade was larger in the PDAA group, and aortic wall volume and calcification were larger in the GDAA group.

Stenting of gastroduodenal artery pseudoaneurysm threatened rupture: report of a case

Gastroduodenal artery (GDA) pseudoaneurysm is a rare surgical entity that causes various symptoms. In the case of rupture, it usually presents an ominous prognosis and mortality rate of up to 40%. Although open surgical procedure is a mainstay, endovascular intervention is emerging a promising treatment in recent years, due to its advantages and safety.We present a case of upper gastrointestinal bleeding caused by GDA pseudoaneurysm threatened rupture in a 71-year-old woman, with medical episodes of acute pancreatitis, a pancreatic body tumor removal surgery was performed, and now the tumor is relapsing and metastasizing. The treatment approach is blocking off the pseudoaneurysm by a covered stent. The procedure was successful and the patient is asymptomatic. Two months later, the pseudoaneurysm reduces its size and completely excluded from the preservation of the blood flow in the artery. Endovascular interventional treatment in the case of GDA aneurysms is considered a promising alternative not only to open surgery but also to an effective emerging technique even in the acute setting.

Stenting of ruptured gastroduodenal artery pseudoaneurysm

Gastroduodenal artery (GDA) aneurysm is a rare surgical entity that causes various symptoms. In the case of rupture, it usually presents an ominous prognosis and mortality rate of up to 40%. Although open surgical procedure is a mainstay, endovascular intervention is emerging a promising treatment in recent years, due to its advantages and safety. We present a case of upper gastrointestinal bleeding caused by ruptured GDA pseudoaneurysmin a 71-year-old woman, with medical episodes of acute pancreatitis, a pancreatic body tumor removal surgery was performed, and now the tumor is relapsing and metastasizing. The treatment approach is blocking off the pseudoaneurysm by a covered stent. The procedure was successful and the patient is asymptomatic. Two months later, the pseudoaneurysm reduces its size and completely excluded from the preservation of the blood flow in the artery.Follow-up to 26 month, patient is well, no symptoms or recurrence. Endovascular interventional treatment in the case of GDA aneurysms is considered a promising alternative not only to open surgery but also to an effective emerging technique even in the acute setting.

Complex Aortic Aneurysm Associated with Multiple Splanchnic Arterial Aneurysms and A Giant Coronary Artery Aneurysm

A 50-year-old male diabetic, hypertensive and chronic smoker presented with complex aortic, splanchnic aneurysms with impending rupture of iliac artery aneurysm, underwent coiling of celiac artery, internal iliac artery, and fenestrated/chimney endovascular aortic repair. One month later, the patient landed in an emergency due to bleeding complications of common hepatic artery and gastroduodenal artery aneurysms, which were managed successfully using endovascular techniques. The mayhem of progressive nature of the disease in the patient continued as he had left lower limb ischemia due to occlusion of the iliac artery and iliac limb of the aortic graft device as he continued to smoke. All of the above sequences of events occurred over a period of 5 years. He also developed a giant aneurysm of left anterior descending of 6.8 cm diameter, which had to be repaired by open surgical technique. The patient has been followed up for 6 years since his first presentation, and he was managed successfully from all the catastrophe of events using endovascular techniques. Giant coronary artery aneurysm with previous aneurysms at multiple sites is quite unusual and rare. Currently, there is no consensus regarding the clinical characteristics, diagnostic method, and the treatment of these cases.

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

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.

A rare case of gastroduodenal artery aneurysm in a highly active antiretroviral therapy induced acute pancreatitis case presenting with lump in abdomen

Gastroduodenal artery (GDA) aneurysm is a rare but potentially fatal vascular disease, with chronic pancreatitis being reported as the commonest etiological factor. Rupture, which is not uncommon, carries a high risk of mortality. The typical patient with palpable epigastric mass, upper gastrointestinal bleeding and pain, may not present in the emergency and the lesion is often picked up incidentally on abdominal ultrasound or a computed tomography. We describe a critical case presenting with lump in abdomen which was found out to be gastroduodenal artery aneurysm on scanning, developing in a patient with recurrent highly active antiretroviral therapy (HAART) induced pancreatitis managed with transfemoral catheter embolization. The patient in question succumbed due to post procedure hepatic failure. The management of aneurysms since historic times have been challenging, the open procedures are being gradually replaced by endovascular techniques, which are yielding better results.

Anévrisme rompu de l’artère gastroduodénale révélé par des hématémèses: à propos d’un cas

L'anévrisme de l'artère gastroduodénale est une lésion vasculaire rare, asymptomatique dans la majorité des cas. Cependant, en cas de rupture de l’anévrisme, le pronostic est mauvais et la mortalité peut atteindre 40%. Nous rapportons le cas d’un patient âgé de 83 ans, qui a présenté brutalement des douleurs abdominales non spécifiques, associées à des hématémèses, et chez qui une fibroscopie a révélé une formation battante comprimant le bulbe duodénal avec un saignement actif, une tomodensitométrie abdominale a été réalisé et a mis en évidence un anévrisme de l’artère gastroduodénale englobant son ostium, et rendant une prise en charge endovasculaire impossible. Une chirurgie ouverte a donc été réalisée, et a consisté en une mise à plat associée à une exclusion de l’anévrisme, puis complétée par une plastie du bulbe. Une tomodensitométrie post-opératoire a confirmé l’exclusion totale de l’anévrisme avec la conservation de la circulation hépatique.

Nonclassical Cause of Obstructive Jaundice: A Case Report of Multiple Visceral Arterial Aneurysms in a Young Patient

Multiple visceral artery aneurysms are relatively rare; the rarest are superior mesenteric artery and gastroduodenal artery aneurysms. The clinical presentation depends on the size and site of the aneurysm. We report the case of a 33-year-old man with recurrent episodes of obstructive jaundice and weight loss. Computed tomography with contrast revealed scattered hepatic arterial aneurysms with two other aneurysms along the course of the left gastro-duodenal and superior mesenteric artery. Investigations to determine the etiology were negative, but the patient had a history of smoking and substance abuse. Angiography revealed an occluded feeding artery. The patient developed multiorgan failure, leading to cardiac arrest and died. Diagnosing multiple visceral artery aneurysms needs a high index of suspicion; early diagnosis enables early intervention, which can reduce the high mortality of this condition.

Assessment of Hepatic Arterial Infusion of Floxuridine in Combination With Systemic Gemcitabine and Oxaliplatin in Patients With Unresectable Intrahepatic Cholangiocarcinoma

Unresectable intrahepatic cholangiocarcinoma (IHC) carries a poor prognosis, with a median overall survival (OS) of 11 months. Hepatic arterial infusion (HAI) of high-dose chemotherapy may have potential benefit in these patients. To evaluate clinical outcomes when HAI chemotherapy is combined with systemic chemotherapy in patients with unresectable IHC. A single-institution, phase 2 clinical trial including 38 patients was conducted with HAI floxuridine plus systemic gemcitabine and oxaliplatin in patients with unresectable IHC at Memorial Sloan Kettering Cancer Center between May 20, 2013, and June 27, 2019. A confirmatory phase 1/2 study using the same therapy was conducted during the same time period at Washington University in St Louis. Patients with histologically confirmed, unresectable IHC were eligible. Resectable metastatic disease to regional lymph nodes and prior systemic therapy were permitted. Patients with distant metastatic disease were excluded. Hepatic arterial infusion of floxuridine and systemic administration of gemcitabine and oxaliplatin. The primary outcome was progression-free survival (PFS) of 80% at 6 months. For the phase 2 clinical trial at Memorial Sloan Kettering Cancer Center, 42 patients with unresectable IHC were included and, of these, 38 patients were treated (13 [34%] men; median [range] age at diagnosis, 64 [39-81] years). The median follow-up was 30.5 months. Twenty-two patients (58%) achieved a partial radiographic response, and 32 patients (84%) achieved disease control at 6 months. Four patients had sufficient response to undergo resection, and 1 patient had a complete pathologic response. The median PFS was 11.8 months (1-sided 90% CI, 11.1) with a 6-month PFS rate of 84.1% (90% CI, 74.8%-infinity), thereby meeting the primary end point (6-month PFS rate, 80%). The median OS was 25.0 months (95% CI, 20.6-not reached), and the 1-year OS rate was 89.5% (95% CI, 80.2%-99.8%). Patients with resectable regional lymph nodes (18 [47%]) showed no difference in OS compared with patients with node-negative disease (24-month OS: lymph node negative: 60%; 95% CI, 40%-91% vs lymph node positive: 50%; 95% CI, 30%-83%; P = .66). Four patients (11%) had grade 4 toxic effects requiring removal from the study (1 portal hypertension, 2 gastroduodenal artery aneurysms, 1 infection in the pump pocket). Subgroup analysis showed significant improvement in survival in patients with IDH1/2 mutated tumors (2-year OS, 90%; 95% CI, 73%-99%) vs wild-type (2-year OS, 33%; 95% CI, 18%-63%) (P = .01). In the Washington University in St Louis confirmatory cohort, 9 patients (90%) achieved disease control at 6 months; the most common grade 3 toxic effect was elevated results of liver function tests, and median PFS was 12.8 months (1-sided 90% CI, 6.4). Hepatic arterial infusion plus systemic chemotherapy appears to be highly active and tolerable in patients with unresectable IHC; further evaluation is warranted.

1393 Calcified Gastroduodenal Artery Aneurysm Presenting as a Pancreatic Mass

INTRODUCTION: Gastroduodenal artery (GDA) aneurysm is among the rarest visceral artery aneurysms (VAAs) with an estimated prevalence of 1.5%. Rarely does it present with an outpouching which can sometimes mimic pancreatic malignancy with vastly different outcomes. We report a case of incidental GDA aneurysm which was mimicking a pancreatic mass where EUS was valuable in diagnosis and management. CASE DESCRIPTION/METHODS: A 63-year-old male with a past medical history of heroin and cocaine abuse, presented to the emergency room with shortness of breath and hypoxia. CT angiography revealed acute bilateral pulmonary embolism along with a pancreatic mass. This finding prompted a triple phase CT scan revealing a round 2.8 × 2.6 cm lesion with peripheral thin calcifications identified as a partially thrombosed GDA aneurysm. Additionally, a 2 × 1.5 cm hypodense area was also noticed. However, it was unclear if this was an outpouching from the aneurysm or a separate pancreatic mass. To better delineate the structure, an endoscopic ultrasonography was then performed. The main pancreatic duct and the pancreatic parenchyma were normal with the exception of a calcified abnormality within the GDA. These calcifications were partly contiguous with the GDA aneurysm. No other structural pathology was reported. Pancreatic biopsies were negative for malignancy. Development of the calcified pseudoaneurysm of the GDA was attributed to cocaine abuse. Thereafter, he underwent successful embolization of the aneurysm due to the high risk of bleeding from the aneurysm. He was thereafter discharged with no further complications. DISCUSSION: The most common etiologies of the GDA aneurysms are pancreatitis and atherosclerosis. Unruptured GDAs may present as abdominal pain or obstructive jaundice or remain asymptomatic. Pancreaticoduodenal and GDA aneurysms may manifest with rupturing into stomach, bile or pancreatic ducts in 50-75% of the cases with mortality approaching 50%. Incidentally found GDA aneurysms, as demonstrated in this case, must be treated irrespective of the size and presence or absence of symptoms since the potential of rupture is unrelated to its size. Given the high mortality, it is imperative to diagnose these lesions early. EUS provides valuable information and is useful in diagnosis as is noticed in our case. Therefore, EUS should definitely be considered in cases where diagnosis of GDA aneurysm is considered.