Piedmont Athens Regional Medical Center Athens, GA, United States
Jasdeep Boparai, MD1, Bannur Nandeesh, MD1, Jasleen Kaur, MD2 1Piedmont Athens Regional Medical Center, Athens, GA; 2Saint Agnes Hospital, Clovis, CA
Introduction: Gastroduodenal artery (GDA) aneurysms accounts for about 1.5% of all visceral artery aneurysms. These can be divided into true and pseudoaneurysms. Pseudoaneurysm of GDA can rarely be associated with peptic ulcer disease . We describe a challenging case of developing pseudoaneurysm of the gastroduodenal artery as a result of erosion of duodenal ulcer.
Case Description/Methods: 77 year old male with history of pancreatic cancer who presented as a transfer from outside facility with complaints of abdominal pain and melena. He already had received 2 units of PRBC’s at outside facility. He also admitted to taking Ibuprofen daily. In the ER, he was noticed to have an episode of coffee ground emesis. On examination, he looked pale and ill appearing. His abdomen was non-tender. Initial vitals showed BP 111/80, pulse 73, Temp 99.1 and RR 18. Initial labs at our facility revealed Hb 7.2, WBC count of 9400 and platelet count of 176,000.
CT abdomen with contrast revealed enlarging pancreatic mass. Gastroduodenal artery courses through the region of mass and is highly stenotic with developing pseudoaneurysm in this region.
It was suspected that the patient has a large ulcer due to NSAIDs use that has eroded into the gastroduodenal artery. Plan was to proceed with CT angiogram and embolization of gastroduodenal artery and then eventual endoscopy to look for the ulcer.
IR guided embolization of gastroduodenal artery was done successfully with multiple coils. Patient then underwent endoscopy and one large, non-bleeding cratered duodenal ulcer was found in the first portion of the duodenum.
Patient did not have any more episodes of bleeding and his hemoglobin was stable at 8.5 at the time of discharge.
Discussion: GDA pseudoaneurysms are commonly associated with chronic pancreatitis followed by alcohol abuse and peptic ulcer disease. Inflammation results in vascular wall destruction leading to pseuodaneursym formation.
In our case, CT evidence of pseudoaneurysm along with high suspicion for duodenal ulcer led us to believe that duodenal ulcer had eroded into the adjacent vessel resulting in pseudoaneurysm.
GDA pseudoaneurysms have a very high chance of rupture and should be repaired whenever possible. Endovascular embolization is now the treatment of choice for visceral artery pseudoaneurysms.
In conclusion, pseuodaneurysm of gastroduodenal artery can arise as a result of peptic ulcer disease and these can be rare source of GI bleeding. High index of suspicion and early diagnosis leads to better outcomes.
Figure: A. CT contrast showing GDA pseudoaneurysm. B. Large duodenal ulcer. C. Coil embolization of the GDA
Jasdeep Boparai indicated no relevant financial relationships.
Bannur Nandeesh indicated no relevant financial relationships.
Jasleen Kaur indicated no relevant financial relationships.
Jasdeep Boparai, MD1, Bannur Nandeesh, MD1, Jasleen Kaur, MD2. P2578 - The Bleeding Giant: An Interesting Case of Developing GDA Pseudoaneurysm Associated With Ulcer, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.