Gastroduodenal Artery Pseudoaneurysm Research Articles

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.

Endovascular treatment of postoperative hemorrhage after pancreatectomy: a retrospective study

BackgroundRuptured aneurysm is a serious complication of distal pancreatectomy (DP) or pancreatoduodenectomy (PD) that can be life-threatening if not treated promptly. This study aimed to examine the efficacy of a Viabahn stent graft for stopping bleeding after pancreatectomy.MethodsBetween April 2016 and June 2022, we performed 245 pancreatectomies in our institution. Six patients experienced postoperative bleeding and underwent endovascular treatment.ResultsAll six cases of bleeding occurred post-PD (3.7%). The bleeding was from gastroduodenal artery (GDA) pseudoaneurysms in three patients, and Viabahn stent grafts were inserted. All three patients did not show liver function abnormalities or hepatic blood flow disorders. One patient with a Viabahn stent graft experienced rebleeding, which required further management to obtain hemostasis. Of the six cases in which there was hemorrhage, one case of bleeding from the native hepatic artery could not be managed.ConclusionsUsing the Viabahn stent graft is an effective treatment option for postoperative bleeding from GDA pseudoaneurysms following PD. In most cases, using this device resulted in successful hemostasis, without observed abnormalities in hepatic function or blood flow.

Blood and bile: A gastroduodenal artery pseudoaneurysm associated with endoscopic retrograde cholangiopancreatography stent migration

A man in his mid-forties presented with a two-day history of sudden onset right upper quadrant pain and coffee-ground vomiting. Eight months previously, he underwent successful endoscopic retrograde cholangiopancreatography (ERCP) with biliary stenting for cholangitis and severe gallstone pancreatitis. This was followed by a COVID-delayed uncomplicated laparoscopic cholecystectomy.

N-butyl-2-cyanoacrylate Packing of a Gastroduodenal Artery Pseudoaneurysm due to Distal Pancreatectomy After Subtotal Esophagectomy.

We describe the successful n-butyl cyanoacrylate (NBCA) packing of a large gastroduodenal artery pseudoaneurysm after distal pancreatectomy in a patient with a history of subtotal esophagectomy and gastric tube reconstruction. The pseudoaneurysm was considered to be caused by direct injury to the gastroduodenal artery (GDA). However, embolization of the GDA was not possible in this case because due to prior esophageal surgery, the main blood vessel supplying the gastric tube was the right epigastric artery from the GDA. Packing a pseudoaneurysm with NBCA is a treatment option when preservation of the parent artery is required.

Pulsation of visible vessel or adherent clot in duodenal ulcer may indicate pseudoaneurysm: Case series.

Owing to the anatomical characteristics of the duodenum, gastroduodenal artery (GDA) pseudoaneurysms can be caused by duodenal ulcers, which may rupture and lead to massive or repeated bleeding. Pseudoaneurysms are usually diagnosed using enhanced computerized tomography or angiography, whereas endoscopic signs have rarely been reported. Three patients aged 18 to 83 years with bleeding duodenal ulcers and GDA pseudoaneurysms were treated. All patients had symptoms of gastrointestinal bleeding, and endoscopy revealed duodenal ulcers with visible vessels or adherent clot pulsations. Angiography confirmed the presence of a GDA pseudoaneurysm, which had an adjacent relationship with the duodenum. The GDA pseudoaneurysm was embolized in each patient. Through transcatheter arterial embolization, endoscopic treatment, and traditional treatment, hematemesis or melena was gradually stopped and all patients were discharged. The pulsation of visible vessels or adherent clots observed during endoscopy in patients with duodenal ulcer may indicate the formation of a gastroduodenal artery pseudoaneurysm. Therefore, we suggest that such patients receive enhanced computerized tomography or angiography to assess whether they need timely endovascular intervention treatment to avoid bleeding caused by a pseudoaneurysm.

Large gastroduodenal artery pseudoaneurysm, arterioportal fistula and portal vein stenosis in chronic pancreatitis treated using combined transarterial embolization and transportal stenting: A case report.

Chronic pancreatitis is an ongoing fibroinflammatory disease of the pancreas characterized by irreversible damage to the pancreatic parenchyma and ductal system. Besides, chronic pancreatitis can present with a variety of life-threatening complications. The patients visited our hospital due to abdominal pain and anemia, and had chronic pancreatitis as an underlying disease. Computed tomography showed a large gastroduodenal artery pseudoaneurysm, arterioportal vein fistula, and portal vein stenosis. We would like to report the successful use of the coils, and N-butyl cyanoacrylate glue for the therapeutic embolization of the pseudoaneurysm and fistula between the gastroduodenal artery and the portal vein, and stenting for portal vein stenosis. On the day following the endovascular management, the patient reported remission of abdominal pain, and hemoglobin level returned to normal after transfusion. It was confirmed that it was still well maintained in the follow-up examination after 1 month. Although chronic pancreatitis causes many vascular complications, simultaneous occurrence of these lesions is extremely rare. Herein, we share our experience with a unique case of an extrahepatic arterioportal fistula induced by the rupture of gastroduodenal artery pseudoaneurysm with concomitant portal vein stenosis. In these complex cases, combined transarterial embolization and transportal stenting can be helpful.

Surgical management of Gastro-duodenal Artery Pseudoaneurysm: A Case Report

Gastro duodenal artery (GDA) Pseudo aneurysm is a rare cause of Upper GIT bleeding. It can be fatal in case of a rupture and has a very high risk of Mortality. Advanced Diagnostic techniques like CT Angiography should be carried out earlier in the disease course for Prompt Diagnosis. Here we discuss a case of a successfully surgically treated GDA pseudo aneurysm Keywords: GDA Pseudo aneurysm; surgical resection; Embolization; Visceral artery Aneurysm

S1912 A Rare Case of Recurrent Hemosuccus Pancreaticus

Introduction: Hemosuccus pancreaticus is a rare cause of GI bleeds characterized by intermittent bleeding from the major duodenal papilla. Chronic pancreatitis, via arterial wall necrosis, can form a visceral pseudoaneurysm in 10% of cases. Here is a rare case of recurrent hemosuccus pancreaticus caused by a gastroduodenal artery (GDA) pseudoaneurysm, despite repeated embolization. Case Description/Methods: A 65-year-old man with alcoholic pancreatitis and pancreaticoduodenal pseudoaneurysm status post embolization in 2019 was being evaluated for hematochezia for 6 months. The patient underwent several negative EGDs and colonoscopies. Video capsule endoscopy showed scant blood streaking in proximal small bowel. Initial CT showed an enlarged pancreas with dilated pancreatic duct. EUS showed a 3x2.5cm well-defined cystic lesion at the pancreatic head with an anechoic center with vascular flow. Repeat CT showed a 1.6cm saccular aneurysmal dilation of the superior pancreaticoduodenal artery (SPDA). Prior to follow-up, he was admitted with hematochezia, with his hemoglobin down from 12 to 7.8. EGD showed blood in the second part of duodenum with fresh oozing from ampulla. An aortogram showed a non-bleeding pseudoaneurysm of the GDA, which was successfully embolized. One month later, he presented again with hematochezia. CTA showed a recurrent 1.5cm pseudoaneurysmal dilation of the SPDA and possible lower GI bleed. Colonoscopy showed dark red blood mixed with stool. NM scan showed a slow bleed from left common/internal iliac artery. An angiogram showed extravasation from the GDA, which was embolized along with the recurrent pseudoaneurysm. Seen 45 days after discharge, the patient was asymptomatic (Figure). Discussion: Hemosuccus pancreaticus caused by GDA pseudoaneurysm is reported in less than 2% of population. Successful embolization in the first 6 months is estimated to be 67%, with rebleeding risk at 37%. Rebleeding is thought to be due to collateral vessels, but in this case, no extravasation was seen after each embolization. Our patient developed recurrent symptoms with development of an aneurysm involving the same artery 1 month later. Recurrence or formation of new pseudoaneurysms usually occur within the first 6 months after embolization. This case is unique in that the patient initially had a successful embolization in 2019 of an aneurysm involving the same artery without any bleeding for 2 years, showing that hemosuccus pancreaticus can recur even after the initial 6 month period after a successful embolization.Figure 1.: A: EGD showing bleeding from ampulla. B: Angiogram of celiac trunk with GDA pseudoaneurysm. C: CTA showed 1.5cm saccular pseudoaneurysmal dilatation of the superior pancreaticoduodenal artery. D: EUS showed a 3.4 x 2.5 cm cystic lesion with anechoic center.

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).

S1889 A Case of Ruptured Gastroduodenal Artery Pseudoaneurysms in a Patient With Chronic Pancreatitis

Introduction: Pancreatic pseudoaneurysm is a rare vascular complication of pancreatitis, with an estimated prevalence of 10%. Pseudoaneurysm can result from trauma, inflammation, infection, and iatrogenic causes. Due to its weak structural support, the risk of rupture is higher for pseudoaneurysm than that of a true aneurysm of similar size. Pancreatic pseudoaneurysms can lead to life-threatening complications such as rupture and bleeding, with increased morbidity and mortality up to 90% in untreated patients and 12.5% despite treatment. Due to its high mortality rate with rupture, pseudoaneurysms should be treated immediately once it is identified, regardless of their size or whether it is symptomatic or not Case Description/Methods: We present a case of a 68-year-old male patient with a past medical history significant for chronic pancreatitis who presented with altered mental status and hypovolemic shock secondary to unexplained gastrointestinal and retroperitoneal hemorrhage (Table). Computed tomography (CT) Angiography was done which showed an enlarging retroperitoneal and right-sided intraperitoneal hematoma with suspicion for active arterial extravasation or punctate pseudoaneurysms in the pancreatic head (Figure). Celiac angiogram was done under fluoroscopic guidance, which showed gastroduodenal and superior pancreaticoduodenal artery pseudoaneurysms. He underwent successful endovascular coil embolization of the gastroduodenal artery. Post procedure he was monitored in intensive care unit. His clinical condition continued to improve and was discharged to a skilled nursing facility in stable condition. Discussion: Physicians should be aware of pancreatic pseudoaneurysms as rare vascular complication associated with chronic pancreatitis that may lead to fatal gastrointestinal or retroperitoneal bleeding with a high mortality rate. Our case highlights the importance of early diagnosis and prompt treatment in these patients.Figure 1.: A: CT abdomen and pelvis without intravenous contrast showing peripancreatic inflammation surrounding the pancreatic body and head along with retroperitoneal bleed (red arrow). Pancreatic calcifications present (yellow arrow) signifying radiologic evidence of chronic pancreatitis B: CT Angiography showing retroperitoneal and right-sided intraperitoneal hematoma with active arterial extravasation or punctate pseudoaneurysms in the pancreatic head. Table 1. - Laboratory Investigation Investigation Day 1 of Hospitalization Day 5 At Time of Discharge Reference Range White Blood Cell count 24.3 14.3 k/uL 7 k/uL 4.8-10.8 k/uL Red Blood Cell Count 4.77 2.69 MIL/uL 3.19 MIL/uL 4.50-5.90 MIL/uL Hemoglobin 15.8 8.5 mg/dl 10.2 mg/dl 12.0-16.0 g/dL Hematocrit 47.6 25.7 % 30.5% 42-51 % Platelet count 171 155 k/uL 215 k/uL 150-400 k/uL Sodium, Serum 132 139 mEq/L 140 mEq/L 135-145 mEq/L Potassium, Serum 3.0 3.2 mEq/L 3.9 mEq/L 3.5-5.0 mEq/L Blood Urea Nitrogen, Serum 41 17 mg/ml 10 mg/ml 8-26 mg/dL Creatinine, Serum 1.2 0.5 mg/dl 0.6 mg/dl 0.5-1.5 mg/dL Bilirubin, Serum total 0.5 0.7 mg/dl 0.3 mg/dl 0.2-1.1 mg/dL Serum Direct Bilirubin 0.3 0.3 mg/dl < 0.2 mg/dl 0.0-0.3 mg/dL Alkaline Phosphatase 51 48 units/L 73 units/L 56-155 unit/L Aspartate Transaminase 125 21 units/L 18 units/L 9-48 unit/L Alanine Aminotransferase 81 30 units /L 12 units /L 5-40 unit/L Lactic acid Level 8.2 0.8 mmoles/L 1.1 mmoles/L 0.5-1.6 mmoles/L Prothrombin Time 15.2 13.9 sec 10.5 sec 9.9-13.3 seconds International Normalized Ratio 1.31 1.20 0.92 0.85-1.14 Serum Calcium 6.6mg/dl 7.6 mg/dl 9.2 3 mg/dl 8.5-10.5 mg/dl Serum Lipase 24 U/L < =61U/L Serum Triglyceride 163mg/gl 55-150 mg/dl Serum Ethanol < 10 < = 10mg/dl Urine Toxicology Cocaine and methadone Negative

Pseudoaneurysm bleed in chronic pancreatitis: beware of multiple feeding vessels-a case report

Gastroduodenal artery (GDA) pseudoaneurysm is a rare but potentially fatal complication in chronic pancreatitis. Managing GI bleed in chronic pseudocyst due to ruptured pseudoaneurysm having multiple feeding vessels and that too in a background of portal hypertension is a challenging task. A 43 year old male patient with chronic calcific pancreatitis presented to our department with 10 days history of malena and drop in hemoglobin. He under micro coil embolization of GDA 12 days before in another hospital for ruptured GDA pseudoaneurysm with upper GI bleed. Upper GI endoscopy revealed grade II-III esophageal varices with portal hypertensive gastropathy with blood in 2nd part of duodenum. CECT scan revealed features of chronic calcific pancreatitis with pseudocyst and GDA pseudoaneurysm with intracystic bleed. Patient again underwent coil embolization in our hospital. However, the patient again developed GI bleed. Patient was taken for emergency laparotomy and found to have bleed from splenic artery as well as GDA pseudoaneurysm into the pseudocyst. Transcystic pseudoaneurysm ligation with ligation of intracystic bleeding vessels and lateral pancreaticojejunostomy was done. Postoperatively patient recovered well. Rupture of pseudoaneurysm in chronic pancreatitis is associated with almost 100% mortality if untreated. Though radiological intervention should be the primary modality of treatment, low threshold for surgery should be kept, considering multiple feeding vessels to the pseudocyst pseudoaneurysm, which may be missed in angiography

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.

Gastroduodenal artery pseudoaneurysm: A rare complication of pancreatitis

Gastroduodenal artery pseudoaneurysms are rare complications of pancreatitis and commonly manifest as abdominal pain and gut bleeding due to rupture. Usually, these vascular complications are asymptomatic and are thus diagnosed incidentally on magnetic resonance imaging or computed tomography examination. Pseudoaneurysms should be treated immediately after diagnosis because of the higher rate of mortality (90%) in untreated cases, whereas 12% in treated cases. Herein, we describe a unique case of gastroduodenal artery pseudoaneurysm in a 29-year-old male patient with chronic pancreatitis, which was treated successfully with embolization.

P-P56 Successful endovascular embolisation of a recurrent gastroduodenal artery aneurysm in a patient presenting with acute on chronic pancreatitis

Abstract Background Pseudoaneurysms are recognised to be a serious complication of chronic pancreatitis. Visceral artery aneurysms (VAA) can be difficult to determine and most commonly occur in the splenic or hepatic artery. Gastroduodenal artery pseudoaneurysms (GDA) have been reported to be the most common VAA following pancreatic surgery. We aim to outline the successful management of a patient with a recurrent 5.5cm GDA pseudoaneurysm following previous embolisation 2 years prior. Methods The 59yr old patient had a history of alcohol related necrotic pancreatitis with pseudocyst formation requiring percutaneous drainage in 2019. This was complicated by pseudoaneurysm formation requiring embolisation of the inferior pancreatico-duodenal artery and GDA. In April 2021 they were readmitted with recurrent abdominal pain thought to be secondary to chronic pancreatitis and one episode of haematemesis. Results Endoscopy revealed inflammation of D1 with signs of recent mucosal bleeding with a recent abdominal ultrasound showing a 4.7x4.6cm apparent pseudocyst. A CT pancreas was performed to assess the pseudocyst however an incidental pseudoaneurysm at the pancreatic head with a sac measuring 5.5cm in diameter and contrast material measuring 3cm in diameter was present. Peripancreatic and retroperitoneal inflammation indicative of acute on chronic pancreatitis. The patient underwent embolisation of the recurrent GDA pseudoaneurysm successfully with no more filling of the previously seen pseudoaneurysm and was safely discharged. Conclusions Recurrent GDA pseudoaneurysms are a very rare complication of recurrent pancreatitis, however should be considered in patients presenting severe epigastric pain with a history of previous pseudoaneurysms.

Ruptured gastroduodenal artery pseudoaneurysm presenting as haematemesis 4 months post lumen‐apposing metallic stent removal

Ruptured gastroduodenal artery pseudoaneurysm presenting as haematemesis 4 months post lumen‐apposing metallic stent removal

Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report

BackgroundHemobilia is a rare cause of upper gastrointestinal bleeding that originates from the biliary tract. It is infrequently considered in diagnosis, especially in the absence of abdominal trauma or history of hepatopancreatobiliary procedure, such as cholecystectomy, which can cause arterial pseudoaneurysm. Prompt diagnosis is crucial because its management strategy is distinct from other types of upper gastrointestinal bleeding. Here, we present a case of massive hemobilia caused by the rupture of a gastroduodenal artery pseudoaneurysm in a patient with a history of laparoscopic cholecystectomy 3 years prior to presentation.Case presentationA 44-year-old Indonesian female presented to the emergency department with complaint of hematemesis and melena accompanied by abdominal pain and icterus. History of an abdominal trauma was denied. However, she reported having undergone a laparoscopic cholecystectomy 3 years prior to presentation. On physical examination, we found anemic conjunctiva and icteric sclera. Nonvariceal bleeding was suspected, but esophagogastroduodenoscopy showed a blood clot at the ampulla of Vater. Angiography showed contrast extravasation from a gastroduodenal artery pseudoaneurysm. The patient underwent pseudoaneurysm ligation and excision surgery to stop the bleeding. After surgery, the patient’s vital signs were stable, and there was no sign of rebleeding.ConclusionGastroduodenal artery pseudoaneurysm is a rare complication of laparoscopic cholecystectomy. The prolonged time interval, as compared with other postcholecystectomy hemobilia cases, resulted in hemobilia not being considered as an etiology of the gastrointestinal bleeding at presentation. Hemobilia should be considered as a possible etiology of gastrointestinal bleeding in patients with history of cholecystectomy, regardless of the time interval between the invasive procedure and onset of bleeding.

Preventive covered stent placement at the gastroduodenal artery stump in angiogram-negative sentinel hemorrhage after pancreaticoduodenectomy.

To evaluate the clinical outcomes of preventive covered stent placement at the gastroduodenal artery stump in patients with angiogram-negative sentinel hemorrhage after pancreaticoduodenectomy. Between July 2006 and September 2018, patients undergoing computed tomography angiography or diagnostic angiography for sentinel hemorrhage after pancreaticoduodenectomy were retrospectively reviewed. Patients having angiogram-negative angiography and undergoing preventive covered stent placement or conservative treatment were included. Clinical outcomes, technique success, and complications were evaluated. A total of 25 patients (mean age 62.5years) were evaluated, including 15 patients underwent preventive covered stent placement at the gastroduodenal artery stump and 10 patients received conservative treatments. The clinical success rates were 50% (5/10) and 86.7% (13/15) for conservative treatments and covered stent groups, respectively (p = 0.07). In the conservative treatment group, delayed massive hemorrhage occurred in five patients, two of whom died of recurrent bleeding due to gastroduodenal artery pseudoaneurysm within 16days, and two had intraluminal hemorrhage within 5days. In the covered stent group, one patient had inferior pancreaticoduodenal artery pseudoaneurysm 1day after the placement of the covered stent, and one had recurrent bleeding due to duodenal ulcer within 14days. The 30-day mortality was 40% (4/10) and 0 in the conservative treatment and covered stent groups, respectively (p = 0.02). The difference in the overall survival was nonsignificant between the two groups (p = 0.23). The preventive covered stent placement at the gastroduodenal artery stump is safe and reduces delayed massive hemorrhage and short-term mortality in patients with angiogram-negative sentinel hemorrhage after pancreaticoduodenectomy.

Gastroduodenal Artery Pseudoaneurysm as a Complication of Pancreatitis Presenting with Lower Gastrointestinal Bleed

Chronic pancreatitis is associated with an uncommon but important complication, the formation of the pseudoaneurysm with an incidence of 10%. The splenic artery is the most common artery affected by pseudoaneurysm. A 55-year-old male patient with pseudoaneurysm of the gastroduodenal artery, an unusual complication of chronic pancreatitis. He presented with haematemesisf and was managed with transfusion of blood and blood products and coil embolisation with the help of digital subtraction angiography. Pseudoaneurysms are one of the rare but important complications of chronic pancreatitis which requires treatment even if they are asymptomatic and incidentally diagnosed on imaging. A history suggestive of upper gastrointestinal bleeding in a case of pancreatitis requires adequate evaluation for source of the bleeding.

Cause rare d'hémorragie digestive haute: rupture d'un faux anévrisme de l'artère gastroduodénale

A 69-year-old female patient with diabetes and hypertension on treatment presented in the emergency department with haematemesis. She reported intermittent epigastric pain evolving for a few days. Clinical examination only showed epigastric susceptibility. Laboratori tests revealed severe normocytic normochromic anemia (Hb=8.3 gr/dl), normal amylasemia with preservation of liver function and coagulation. Patient´s outcome was marked by decline in haemoglobin concentrations and haemodynamic instability despite good venous filling and blood transfusion. Given the nonavailability of urgent digestive endoscopy, abdominal angioscan showed gastroduodenal artery pseudoaneurysm measuring 6mm along its longer axis without signs of active leakage or intraperitoneal effusion, associated with choledocoduodenal fistula. The diagnosis of heavy upper gastrointestinal bleeding secondary to gastroduodenal artery pseudoaneurysm rupture was retained. The patient underwent emergency surgery given the nonavailability of arterial embolization through vascular ligation. Patient´s outcome was favorable with stabilization of haemoglobin level and hemodynamic status.

Hemosuccus Pancreaticus: Mysterious Cause of Gastrointestinal Bleeding and Pain

Hemosuccus pancreaticus is a very rare but severe form of upper gastrointestinal hemorrhage. The most common etiology is peripancreatic pseudoaneurysm secondary to chronic pancreatitis. These pseudoaneurysms may either bleed intra abdominally following rupture or may erode into the adjacent hollow viscera and manifest as gastrointestinal bleeding. Pseudoaneurysms rarely communicate with the pancreatic duct and bleeding occurs from the ampulla of Vater in the form of hemosuccus pancreaticus. Due to the rarity of gastroduodenal artery pseudoaneurysms, most of the current literature consists of case reports. Limited knowledge about the disease causes diagnostic difficulty.