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Verigou EA, Skajaa N, Tanwar H. Spontaneous hepatic artery pseudoaneurysm rupture as a first presentation of polyarteritis nodosa. BMJ Case Rep 2024; 17:e257411. [PMID: 38937262 DOI: 10.1136/bcr-2023-257411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
A man in his 70s presented with a sudden onset stabbing back pain radiating to the chest and pre-syncopal symptoms. He underwent urgent investigations, including a CT angiogram aorta which did not reveal any abnormalities within the thorax, abdomen or pelvis and no cause of symptoms was identified. After being discharged, he re-presented 2 days later with syncopal episodes, abdominal pain and a significant drop in haemoglobin levels. This time, a CT mesenteric angiogram showed two hepatic artery pseudoaneurysms and a large haemoperitoneum. Following a hepatic artery embolisation, a workup showed that the likely cause of the pseudoaneurysms was a rare first presentation of polyarteritis nodosa. This case highlights the importance of considering the possibility of an aneurysmal rupture, especially when common causes of an acute abdomen have been excluded, and not relying on previous negative investigations to exclude pathology, as the outcomes can be detrimental.
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Affiliation(s)
| | | | - Hitendra Tanwar
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
- Urgent and emergency care [UEC] Acute Medicine, East Kent Hospital University Foundation Trust, Ashford, Kent, UK
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2
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Almadwahi NY, Alshuja’a MA, Al-Hodiafy HZ, Jowah HM. A Rare Case of Gastroduodenal Artery Aneurysm Rupture with Perforated Duodenal Ulcer. Int Med Case Rep J 2024; 17:609-614. [PMID: 38911607 PMCID: PMC11192190 DOI: 10.2147/imcrj.s468278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/14/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose In this case we report a rare presentation of a ruptured gastroduodenal artery aneurysm (GDA) accompanied by a duodenal perforation. It contributes to the scientific literature by discussing the management approach and results in a patient with dual complications and emphasizes the importance of early diagnosis and appropriate treatment. Case presentation A 50-year-old male presented with severe abdominal pain, anemia, and signs of hemodynamic instability. Diagnostic imaging including CTA revealed a large, thrombosed gastroduodenal artery aneurysm with evidence of rupture. The patient underwent open surgical exploration and repair to address both the aneurysm and the duodenal perforation. The patient's recovery was satisfactory and was discharged home in stable condition. Conclusion Early diagnosis and appropriate management in gastroduodenal artery aneurysms is crucial. There is a need for individualized surgical interventions based on the patient's hemodynamic status and associated complications. Dual complications required open surgical exploration and repair, resulting in favorable outcomes.
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Affiliation(s)
| | | | - Hamza Zaid Al-Hodiafy
- Department of Vascular Surgery, 48 Model Hospital, Sana’a University, Sana’a City, Yemen
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3
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Tran LT, Dada JA, Meadows JM, Willard MD. Over-the-Scope-Clip Iatrogenic Ligation of the Gastroduodenal Artery: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943891. [PMID: 38853402 PMCID: PMC11180477 DOI: 10.12659/ajcr.943891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
BACKGROUND The Over-the-Scope-Clip (OTSC) System is a class of endoscopic clips intended to provide improved strength and tissue capture compared to conventional through-the-scope clips. These clips are generally safe and effective in managing many gastrointestinal conditions, with a low overall adverse event rate. Although the OTSC has been used to treat gastrointestinal bleeding and bowel perforations for many years, it often is relegated to second-line therapy and has only recently become a first-line hemostatic therapy for gastrointestinal bleeding. CASE REPORT Here, we present a unique adverse event of the OTSC causing iatrogenic ligation of the gastroduodenal artery (GDA). A 71-year-old man presented with 6 months of epigastric abdominal pain and 2 weeks of hematemesis, and was ultimately diagnosed with a bleeding duodenal ulcer. He underwent multiple endoscopic interventions to attempt to control the duodenal ulcer bleeding, including placement of the OTSC on a visible vessel. Soon after OTSC placement, he became hypotensive with recurrent hematochezia, and Interventional Radiology was consulted for endovascular management of the bleeding. Angiography showed the OTSC had been deployed across the midportion of the GDA from the duodenal lumen, effectively ligating the GDA, causing bleeding due to direct vascular injury. This bleeding was ultimately controlled with coil embolization. However, this iatrogenic ligation of the midportion of the GDA by the OTSC significantly complicated endovascular intervention to control the bleeding. CONCLUSIONS As the OTSC device becomes more commonly used in the endoscopy suite, it is important to share potential pitfalls that may be encountered in the clinical setting that impact not only endoscopists and patients, but other specialties as well.
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Affiliation(s)
- Loc Truong Tran
- Department of Medicine, CAMC Institute for Academic Medicine, Charleston, WV, USA
| | - Jafar A Dada
- Department of Radiology, West Virginia University Hospital, Morgantown, WV, USA
| | | | - Megan Dunnigan Willard
- Division of Gastroenterology & Hepatology, Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
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Rahman NA, Lieb KR, Choudhry A, Chihade DB, Feghali A. Endovascular Coil Embolization of an Enlarging Gastroduodenal Artery Aneurysm. Vasc Endovascular Surg 2024; 58:410-413. [PMID: 37966482 DOI: 10.1177/15385744231215551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Gastroduodenal artery aneurysms are a rare type of visceral aneurysm that can lead to rupture and death. We present a 75-year-old male with history of hypertension, diabetes, and hyperlipidemia with an incidental finding of a 3.2 × 3.7 cm gastroduodenal aneurysm found on abdominal computed tomography angiography (CTA). After refusing surgical intervention, he was seen two years later and presented with an enlarged gastroduodenal aneurysm, now 5.0 × 5.1 cm, visible on a repeat abdominal CTA. Upon his continued refusal for an open surgery, we elected for endovascular repair of this GDA aneurysm via coil embolization.
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Affiliation(s)
- Naveed A Rahman
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Kayla R Lieb
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Asad Choudhry
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Deena B Chihade
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Anthony Feghali
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
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Shehzad D, Khan D, Shehzad M, Khan W, Chaudhry H, Oliver T. Gastroduodenal artery aneurysm - an extremely rare but insidious cause of abdominal pain: a case report. Pan Afr Med J 2024; 47:77. [PMID: 38708132 PMCID: PMC11068471 DOI: 10.11604/pamj.2024.47.77.42605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/04/2024] [Indexed: 05/07/2024] Open
Abstract
An arterial aneurysm is a localized weakening of the artery wall that results in pathological dilatation. All intra-abdominal artery aneurysms are labeled as visceral artery aneurysms (VAA), apart from the aorto-iliac artery aneurysms. VAA´s are rare, gastroduodenal artery aneurysms (GDAA), constituting 1.5% of visceral artery aneurysms. A woman in her early 80s´ presented with chronic epigastric pain, weight loss, and nausea. Conservative management was unsuccessful. Imaging revealed a GDAA, prompting endovascular coil embolization. Subsequent evaluation confirmed Polyarteritis Nodosa (PAN), treated with rituximab. The report underscores the diagnostic challenges, emphasizing the need for a multidisciplinary approach using imaging and angiography. GDAA's potential life-threatening rupture necessitates prompt intervention, as illustrated in this case. The rare association with PAN, although infrequent, underscores the importance of considering underlying etiologies in multiple visceral aneurysms. Early diagnosis and intervention are pivotal for this uncommon yet potentially lethal condition.
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Affiliation(s)
- Dawood Shehzad
- Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, South Dakota, United States of America
| | - Dawlat Khan
- Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, South Dakota, United States of America
| | - Mustafa Shehzad
- Hackensack University Medical Center, Hackensack, United States of America
| | - Wahab Khan
- Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, South Dakota, United States of America
| | - Hammad Chaudhry
- Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, South Dakota, United States of America
| | - Tony Oliver
- Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, South Dakota, United States of America
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Lu T, Shen R, Xv M, Ye Q, Shen J. Successful endoscopic combined with endovascular haemostasis of a ruptured pseudoaneurysm of the duodenal bulb: A case report. J Int Med Res 2024; 52:3000605231222413. [PMID: 38179804 PMCID: PMC10771055 DOI: 10.1177/03000605231222413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
Pseudoaneurysms are uncommon but their rupture and bleeding can lead to serious complications and be fatal. We present here a case of a man in his late 70s who was transferred to our hospital with persistent gastrointestinal bleeding. One month prior to his admission, he had undergone surgery for a fracture to his left knee. Endoscopic examination found pulsating blood vessels on a duodenal ulcer, which suddenly ruptured and caused significant bleeding. Immediate endoscopic haemostasis was administered and the bleeding decreased. Considering the high rate of rebleeding that may occur with a pseudoaneurysm, the patient underwent interventional radiology that culminated in a diagnosis of a pseudoaneurysm originating from gastroduodenal artery (GDA); successful embolization was achieved. Tests showed that the patient had Helicobacter pylori infection. We hypothesised that the H. pylori infection had led to the occurrence of the duodenal bulb ulcer, and the patient's left knee fracture and surgery a month previously had contributed to this predisposition for a pseudoaneurysm.
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Affiliation(s)
- Ting Lu
- Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo, ZheJiang Province, China
| | - Ruiwei Shen
- Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo, ZheJiang Province, China
| | - Minhong Xv
- Department of Endoscopy Center, Ningbo Medical Center Lihuili Hospital, Ningbo, ZheJiang Province, China
| | - Qunqun Ye
- Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo, ZheJiang Province, China
| | - Jianwei Shen
- Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo, ZheJiang Province, China
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Bouhout T, Kharkhach A, Ramdani A, Harouachi A, Serji B. Pseudoaneurysm of the Gastroduodenal Artery: A Rare Complication of Bile Duct Surgery. Cureus 2024; 16:e53209. [PMID: 38425630 PMCID: PMC10902725 DOI: 10.7759/cureus.53209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Pseudoaneurysm of the gastroduodenal artery (GDA) is an exceptional complication of common bile duct (CBD) resection. We present the case of a 60-year-old woman with a history of cholecystectomy. The patient was admitted to our hospital for surgical management of the cystic dilatation of the CBD. The patient presented on postoperative day 21 with hemodynamic instability related to a pseudoaneurysm of the GDA. An urgent open surgery was performed with dissection and ligation of the GDA.
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Affiliation(s)
- Tariq Bouhout
- Department of Surgical Oncology, Oncology Hospital of Oujda, Faculty of Medicine and Pharmacy of Oujda, University Mohamed Premier, Oujda, MAR
| | - Ayoub Kharkhach
- Department of Surgical Oncology, Oncology Hospital of Oujda, Faculty of Medicine and Pharmacy of Oujda, University Mohamed Premier, Oujda, MAR
| | - Abdelbassir Ramdani
- Department of Surgical Oncology, Oncology Hospital of Oujda, Faculty of Medicine and Pharmacy of Oujda, University Mohamed Premier, Oujda, MAR
| | - Abdelhakim Harouachi
- Department of Surgical Oncology, Oncology Hospital of Oujda, Faculty of Medicine and Pharmacy of Oujda, University Mohamed Premier, Oujda, MAR
| | - Badr Serji
- Department of Surgical Oncology, Oncology Hospital of Oujda, Faculty of Medicine and Pharmacy of Oujda, University Mohamed Premier, Oujda, MAR
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Guo H, Stach J, Belletrutti PJ. A Rare Cause of Life-Threatening Upper Gastrointestinal Bleeding. Gastroenterology 2023; 165:1118-1121. [PMID: 37245591 DOI: 10.1053/j.gastro.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Howard Guo
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jesse Stach
- Department of Medicine, Section of Gastroenterology and General Internal Medicine, Medicine Hat Regional Hospital, Medicine Hat, Alberta, Canada
| | - Paul J Belletrutti
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Barka M, Rguez A, Ben Cheikh Y, Chaouch MA, Jarrar MS, Ben Abdessalem Z, Hamila F, Youssef S. A case report of gastroduodenal artery pseudoaneurysm and giant pancreatic pseudocyst following acute pancreatitis revealed by obstructive jaundice. SAGE Open Med Case Rep 2023; 11:2050313X231188885. [PMID: 37529080 PMCID: PMC10387759 DOI: 10.1177/2050313x231188885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Acute necrotic pancreatitis is an emergency of evolution and is often unpredictable because of the potentially life-threatening complications it can cause. We report a unique case of a 56-year-old woman hospitalized for acute necrotic pancreatitis. The evolution of the latter was characterized by the occurrence of two very rare complications, of which the clinical presentations were atypical. The first complication was a gastroduodenal pseudoaneurysm compressing the main biliary tract and causing obstructive jaundice, which evolved well following percutaneous embolization. The second complication was a giant 20 cm pancreatic pseudocyst revealed by obstructive jaundice secondary to biliary compression, which progressed well following surgical treatment.
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Affiliation(s)
- Malek Barka
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Arib Rguez
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Yasser Ben Cheikh
- Department of Radiology, Sahloul University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Mohamed Ali Chaouch
- Department of General and Digestive Surgery, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
| | - Mohamed Salah Jarrar
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Zied Ben Abdessalem
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Fehmi Hamila
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Sabri Youssef
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
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Taneja V, Shah D, Dessai R, Sondhi M, Nautiyal M, Garg A. Recurrent idiopathic pancreatitis complicating as emphysematous pancreatitis and gastroduodenal artery pseudoaneurysm: A rare case report. Ann Afr Med 2023; 22:385-387. [PMID: 37417030 PMCID: PMC10445719 DOI: 10.4103/aam.aam_245_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/17/2022] [Indexed: 07/08/2023] Open
Abstract
Emphysematous pancreatitis (EP) is a rare and potentially fatal condition of the pancreas. It is associated with gas-forming bacteria and is characterized by the presence of gas in or around the pancreas. It is identified by a computed tomography scan of the abdomen. Although predisposing factors are not precisely known, diabetes mellitus, which predisposes to gas gangrene, is seen to be commonly associated with patients of EP. EP being potentially fatal requires immediate management. Surgery is generally indicated in EP. However, EP can also managed conservatively. In our case, the patient developed recurrent pancreatitis, the cause being idiopathic, and the second episode of acute pancreatitis was complicated by EP and gastroduodenal artery pseudoaneurysm.
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Affiliation(s)
- Vinus Taneja
- Department of Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Darshit Shah
- Department of Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Rishikesh Dessai
- Department of Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Manuj Sondhi
- Department of Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Manishi Nautiyal
- Department of Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Ambuj Garg
- Department of Medicine, Sir Ganga Ram Hospital, New Delhi, India
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Zhou YY, Wang SC, Seak CJ, Huang SW, Cheng HT. Case report: Duodenal obstruction caused by gastroduodenal artery pseudoaneurysm with hematoma: an unusual case and literature review. Front Med (Lausanne) 2023; 10:1198378. [PMID: 37425331 PMCID: PMC10325565 DOI: 10.3389/fmed.2023.1198378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Visceral artery pseudoaneurysm is a rare disease that most commonly occurs in male patients in their 50s, with gastroduodenal artery (GDA) pseudoaneurysm accounting for only 1.5% of these. The treatment options generally include open surgery and endovascular treatment. In 40 cases of GDA pseudoaneurysm from 2001 to 2022, endovascular therapy was the mainstay of treatment in 30 cases, and most of them (77%) were treated by coil embolization. Our case report describes a 76-year-old female patient with a GDA pseudoaneurysm, which was treated by endovascular embolization using liquid embolic agent N-butyl-2-cyanoacrylate (NBCA) alone. This is the first time this treatment strategy has been used for GDA pseudoaneurysm. We demonstrate a successful outcome with this unique treatment. The successful experience of our case may provide a new treatment strategy for this rare disease.
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Affiliation(s)
- Yan-Yuan Zhou
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Chung Wang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, New Taipei Municipal Tucheng Hospital, Chang Gung Medical foundation, New Taipei City, Taiwan
| | - Chen-June Seak
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Emergency Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Shu-Wei Huang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Hao-Tsai Cheng
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
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Ju J, Cheng Z, Zhu Q, Deng M, Zhang H. Pulsation of visible vessel or adherent clot in duodenal ulcer may indicate pseudoaneurysm: Case series. Medicine (Baltimore) 2023; 102:e32819. [PMID: 36749253 PMCID: PMC9902009 DOI: 10.1097/md.0000000000032819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
RATIONALE 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. PATIENT CONCERNS Three patients aged 18 to 83 years with bleeding duodenal ulcers and GDA pseudoaneurysms were treated. DIAGNOSIS 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. INTERVENTIONS The GDA pseudoaneurysm was embolized in each patient. OUTCOMES Through transcatheter arterial embolization, endoscopic treatment, and traditional treatment, hematemesis or melena was gradually stopped and all patients were discharged. LESSONS 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.
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Affiliation(s)
- Jiayu Ju
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Ziyao Cheng
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Qingliang Zhu
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Mingming Deng
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Hailong Zhang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
- * Correspondence: Hailong Zhang, The Affiliated Hospital of Southwest Medical University, No. 25, Taiping Street, Luzhou, Sichuan Province 64600, China (e-mail: )
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Muacevic A, Adler JR, Nagendra V, Suryadevara M, Shetty N. Giant Abdominal Pseudoaneurysm Secondary to Recurrent Pancreatitis: Imaging and Endovascular Intervention. Cureus 2022; 14:e32872. [PMID: 36699761 PMCID: PMC9870600 DOI: 10.7759/cureus.32872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/23/2022] [Indexed: 12/24/2022] Open
Abstract
Chronic or necrotizing pancreatitis is characterized by repeated inflammation of the pancreas, leading to multiple complications, a few of which are vascular, such as splanchnic venous thrombosis and arterial pseudoaneurysms. Even though the frequency of pseudoaneurysm formation in patients with pancreatitis is as high as 10%, there is not much importance given to its management in the radiologic literature. The splenic artery is the most common visceral artery affected by pseudoaneurysms, followed by the gastroduodenal and pancreaticoduodenal arteries. Usually, pseudoaneurysms occur due to the erosion of a peripancreatic or pancreatic artery into a pseudocyst, but this can also occur without the development of a pseudocyst. Pseudoaneurysms may be asymptomatic (usually the ones less than 5 cm), but some of them may pose a threat due to spontaneous rupture and subsequent fistulization into other organs. Therefore, early diagnosis and management are of prime importance. Here, in this article, we present a case of pseudoaneurysm of the gastroduodenal artery with characteristic imaging features and preferred, recent techniques of management.
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Alam AS, Elkhawaga M, Yashi K. Gastroduodenal Artery Pseudoaneurysm: A Rare Cause of Upper Gastrointestinal Bleeding and Pancreatic Duct Compression. Cureus 2022; 14:e29971. [DOI: 10.7759/cureus.29971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
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Takashima J, Taniguchi K, Koizumi A, Shigehara F, Yamazaki K, Fujimoto D, Miura F, Kobayashi H. Ruptured ileocolic artery pseudoaneurysm after laparoscopic appendectomy for acute appendicitis. Surg Case Rep 2022; 8:186. [PMID: 36173516 PMCID: PMC9522962 DOI: 10.1186/s40792-022-01538-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/19/2022] [Indexed: 12/04/2022] Open
Abstract
Background A pseudoaneurysm of the splanchnic vessels is considered to be rare, and in particular, very few cases of pseudoaneurysm in the ileocolic artery are reported. Here, we report a case of rupture of a pseudoaneurysm of the appendicular branch of the ileocolic artery after laparoscopic appendectomy. Case presentation A 52-year-old man was diagnosed as having phlegmonous appendicitis, and an emergency laparoscopic appendectomy was performed. Bleeding from the inter-appendicular ligament during detachment of adhesions was stopped by white coagulation and Z-suture, and the inter-appendicular ligament was treated. The postoperative course was uneventful, and there were no adverse events or findings suggestive of abscess formation. On postoperative day 30, he presented with a ruptured pseudoaneurysm of the appendicular branch of the ileocolic artery. A definitive diagnosis was made by computed tomography, and emergency interventional radiology was performed with hemostasis achieved by coiling. The patient’s postprocedure course was favorable, and he was discharged with no adverse events, such as intestinal ischemia. Conclusions We experienced a case of delayed pseudoaneurysm rupture after laparoscopic appendectomy. Care must be taken when handling the appendicular artery during the procedure, and the potential for pseudoaneurysm formation should be considered at postoperative follow-up.
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Vincenzi P, Gaudenzi D, Mulazzani L, Rebonato A, Patriti A. Crohn's Disease and Jejunal Artery Aneurysms: A Report of the First Case and a Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1344. [PMID: 36295505 PMCID: PMC9611918 DOI: 10.3390/medicina58101344] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/01/2022] [Accepted: 09/21/2022] [Indexed: 12/01/2023]
Abstract
Background and Objectives: Jejunal artery (JA) and ileal artery (IA) aneurysms constitute less than 3% of all visceral artery aneurysms (VAAs), carrying a risk of rupture as high as 30%, and a mortality of 20%. Though many etiologies have been reported in the literature, no mention exists on a causal association between these aneurysms and inflammatory bowel diseases (IBD). We present the first case of a JA aneurysm related to Crohn's Disease (CD) together with a review of the literature. Materials and Methods: A 74-year-old male presenting with CD intestinal relapse and an incidental finding at the computed tomography enterography (CTE) of a 53 × 47 × 25mm apparently intact JA pseudoaneurysm, arising from the first and second jejunal branches, underwent coil embolization followed by small bowel resection, with an uneventful outcome. We also included the review of literature on JA and IA aneurysms, analyzing all reports published in PubMed and Scopus from 1943 to July 2022. Results: 60 manuscripts with 103 cases of JA and IA aneurysms in 100 patients were identified. Among cases with available data, 34 (33.0%) presented acutely with rupture, 45 (43.7%) were described as non-ruptured. 83 (80.6%), and 14 (13.6%) were JA and IA aneurysms, respectively, having a median size of 15 (range:3.5-52) mm. Atherosclerosis (16.5%), infections (10.7%), and vasculitides/connective tissue disorders (9.7%) represented the main causes mentioned. Mean age was 53.6 (±19.2) years, male patients being 59.4%. One third of patients (32.4%) were asymptomatic. Overall, treatment was indicated in 63% of patients, with surgery and endovascular procedures performed in 61.9% and 38.1% cases, respectively. The technical success rate of endovascular treatment (EVT) was 95.8%. The mortality rate was 11.8%, being higher (21.2%) in the rupture group. Conclusions: The prompt treatment accomplished in our case granted a successful outcome. JA and IA aneurysms should be included among local complications of IBD. Considering their high potential for rupture, regardless of size, a low threshold for endovascular or surgical treatment should be applied.
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Affiliation(s)
- Paolo Vincenzi
- Department of Surgery, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, 61121 Pesaro, Italy
| | - Diletta Gaudenzi
- Department of Perioperative Services, AOU Ospedali Riuniti di Ancona, Via Conca n 71, 60126 Ancona, Italy
| | - Luca Mulazzani
- Department of Radiology, Division of Interventional Radiology, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, 61121 Pesaro, Italy
| | - Alberto Rebonato
- Department of Radiology, Division of Interventional Radiology, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, 61121 Pesaro, Italy
| | - Alberto Patriti
- Department of Surgery, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, 61121 Pesaro, Italy
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17
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Sherwani P, Kumar KSS, Sharma P, Dua R, Layek A. Ruptured spontaneous bronchial artery pseudo aneurysm with large mediastinal hematoma and its interventional management: An acute chest emergency. Lung India 2022; 39:204-207. [PMID: 35259809 PMCID: PMC9053928 DOI: 10.4103/lungindia.lungindia_540_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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McGuire A, Capron B. Outpatient Management of Gastroduodenal Artery Aneurysm. Cureus 2021; 13:e19091. [PMID: 34858746 PMCID: PMC8614177 DOI: 10.7759/cureus.19091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 12/02/2022] Open
Abstract
Gastroduodenal artery (GDA) aneurysms are exceptionally rare. Although rare, providers should have a sufficient understanding of the causes, symptoms, and treatment options due to there being a high risk of mortality if these aneurysms rupture. It is important to understand the need for close management and follow-up in patients with this diagnosis, especially in the outpatient setting. Various treatment options are available and should be immediately discussed with every patient diagnosed with this aneurysm. We report a patient with a previously diagnosed gastroduodenal aneurysm who presented to the clinic with new-onset symptoms.
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Affiliation(s)
| | - Brianna Capron
- Family Medicine, University of Pikeville-Kentucky College of Osteopathic Medicine, Pikeville, USA
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19
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Successful Minimally Invasive Management of a Gastroduodenal Artery Pseudoaneurysm Causing Extrinsic Bile Duct Compression. ACG Case Rep J 2021; 8:e00663. [PMID: 34646903 PMCID: PMC8500591 DOI: 10.14309/crj.0000000000000663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/31/2021] [Indexed: 11/17/2022] Open
Abstract
Gastroduodenal artery (GDA) pseudoaneurysms are rare clinical entities that typically develop in the setting of chronic inflammation of the pancreas, although idiopathic pseudoaneurysms can occur. Although GDA pseudoaneurysms carry the risk of rupture with resultant hemorrhage, they seldom are reported to cause biliary obstruction. We report a unique case of biliary obstruction secondary to extrinsic compression of the bile duct by a GDA pseudoaneurysm successfully managed by nonoperative means.
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20
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Abetz JW, Mangira D, Ng MK. Ruptured gastroduodenal artery pseudoaneurysm presenting as haematemesis 4 months post lumen-apposing metallic stent removal. ANZ J Surg 2021; 92:904-905. [PMID: 34605592 DOI: 10.1111/ans.17190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Jeremy W Abetz
- Department of Surgery, Ballarat Health Services, Ballarat Central, Victoria, Australia
| | - Dileep Mangira
- Department of Internal Medicine, Ballarat Health Services, Ballarat Central, Victoria, Australia.,Department of Gastroenterology, Western Health, Footscray, Victoria, Australia.,Specialist Centre Ballarat, Ballarat Central, Victoria, Australia
| | - Michael K Ng
- Department of Surgery, Ballarat Health Services, Ballarat Central, Victoria, Australia.,Specialist Centre Ballarat, Ballarat Central, Victoria, Australia
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21
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Zerti HM, Saleem MS, Khan YI, Iqbal Z, Ninalowo H. Small Bowel Obstruction: A Rare Presentation of the Inferior Pancreaticoduodenal Artery Pseudoaneurysm Bleed. Cureus 2021; 13:e16943. [PMID: 34513511 PMCID: PMC8418819 DOI: 10.7759/cureus.16943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 12/02/2022] Open
Abstract
Intra-abdominal and intramural hematomas are well-known complications of pseudoaneurysms. We present a case of small bowel obstruction as a result of external mechanical compression from hematoma. Bleeding was localized to the pseudoaneurysm of the gastroduodenal artery and inferior pancreaticoduodenal artery. Angiography was used to control the bleeding with coil embolization. This rare clinical manifestation represents just one of the symptoms associated with pseudoaneurysms of the gastrointestinal tract. Therapeutic options are discussed along with a review of the literature.
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Affiliation(s)
- Hasan M Zerti
- Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes Barre, USA
| | | | | | - Zaid Iqbal
- Internal Medicine, Wright Cen, Scranton, USA
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22
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Kurniawan K, Wibawa IDN, Somayana G, Mariadi IK, Mulyawan IM. Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report. J Med Case Rep 2021; 15:331. [PMID: 34210350 PMCID: PMC8252212 DOI: 10.1186/s13256-021-02915-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/18/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hemobilia 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 PRESENTATION A 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. CONCLUSION Gastroduodenal 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.
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Affiliation(s)
- Kurniawan Kurniawan
- Department of Internal Medicine, Faculty of Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - I Dewa Nyoman Wibawa
- Gastroentero-Hepatology Division, Department of Internal Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - Gde Somayana
- Gastroentero-Hepatology Division, Department of Internal Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - I Ketut Mariadi
- Gastroentero-Hepatology Division, Department of Internal Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia.
| | - I Made Mulyawan
- Digestive Surgery Division, Department of General Surgery, Faculty of Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia
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23
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Metzger PB, Costa KR, Silva SLE, Gouveia AC, Berbert MQ, Mello MODA, de Oliveira FM, Melo RFF. Inferior pancreaticoduodenal artery aneurysm: endovascular approach. J Vasc Bras 2021; 20:e20200101. [PMID: 34093677 PMCID: PMC8147707 DOI: 10.1590/1677-5449.200101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aneurysms of the pancreaticoduodenal arteries are a rare condition. In the majority of cases, diagnosis is made in emergency situations due to complications such as rupture, which is associated with high mortality rates (21-26%). Embolization of the aneurysm sac is the treatment of choice, because of its high efficacy and lower mortality. This article presents and discusses a case of inferior pancreaticoduodenal artery aneurysm that was diagnosed during investigation of gastrointestinal symptoms. The treatment provided was microcoil embolization, with complete exclusion of the aneurysm and a good clinical course.
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24
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Shrestha A, Shrestha A, Ghimire B. A Ruptured Pseudoaneurysm of an Anomalous Gastroduodenal Artery: A Rare Presentation. Cureus 2021; 13:e14899. [PMID: 34113512 PMCID: PMC8184106 DOI: 10.7759/cureus.14899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Gastroduodenal artery (GDA) anomalies are a rare entity. Rupture of such anomalies can present with a diagnostic challenge. In this report, we describe a case of ruptured pseudoaneurysm of an anomalous GDA arising directly from the aorta presenting with recurrent abdominal pain and anemia. The diagnosis was made on computed tomography scan which showed acute retroperitoneal fluid collection. Further angiographic intervention highlighted the anomalous GDA arising directly from the aorta.
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Affiliation(s)
- Anish Shrestha
- Department of Gastrointestinal and General Surgery, Institute of Medicine, Kathmandu, NPL
| | - Anisha Shrestha
- Department of Gastrointestinal and General Surgery, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, NPL
| | - Bikal Ghimire
- Department of Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL.,Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, NPL
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25
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Anwar MN, Anthony N, Amin QK, Yousafzai ZA, Khalil H. An Undiagnosed Case of Chronic Pancreatitis With Multiple Visceral Arteries Pseudoaneurysm. Cureus 2021; 13:e14789. [PMID: 34094751 PMCID: PMC8169010 DOI: 10.7759/cureus.14789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Visceral artery aneurysms, which could be either true or pseudo, are abnormal focal dilations of vessels supplying the abdominal organs. True aneurysms, by definition, suggest dilation of the vessel in response to increased blood flow, ultimately causing a blood-filled sac to form. Pseudoaneurysm, however, is the pooling of blood in surrounding tissues secondary to trauma or rupture. A 43-year-old woman G9 P9, known hypertensive was admitted electively for investigation of melena, hematemesis, hematochezia for one week along with weight loss and epigastric pain. Laboratory studies showed mild anemia with a hemoglobin level of 9.6 g/dL, hematocrit 29.5%, mean corpuscular hemoglobin (MCH) 26.7, upon which she was transfused two pints of blood and commenced at Injectable Vitamin K, injectable transamine, and infusion omeprazole. Two days later her levels improved to HB 12.4 g/dL, hematocrit 37.5%, MCH 26.7 pg, RBC 4.64 × 10*12/L. while being on treatment, a computed tomography (CT) mesenteric angiography was also conducted that showed multiple splanchnic pseudoaneurysms involving celiac axis trifurcation, gastroduodenal artery, superior/inferior pancreaticoduodenal artery, and jejunoileal branch of the superior mesenteric artery, and a large partially thrombosed pseudoaneurysm arising from superior pancreaticoduodenal branch causing significant mass effect on the second part of duodenum. On the basis of such findings, it was advised to perform coiling and embolization of the corresponding arteries. Multiple other small aneurysms with secondary arteriovenous malformations (AVM) were also seen. The whole circuit of flow retrograde and antegrade along with the aneurysm sac was blocked with multiple coils of variable sizes. An angiogram was repeated that revealed a good outcome. Pseudoaneurysms of the visceral arteries are very rare and affect mainly the splenic artery. The rarest of which is gastroduodenal artery (1.5%), pancreaticoduodenal artery (2%), and coeliac truck (4%). Therefore, this can be an incidental finding. The diagnosis is usually made with an angiography combined with clinical presentation. Variable treatment options are available depending on the patient’s fitness and hemodynamic stability. The endovascular approach, however, is mostly used in such cases.
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Affiliation(s)
| | - Nouman Anthony
- General Medicine, Rehman Medical Institue, Peshawar, PAK
| | | | | | - Hira Khalil
- General Medicine, Rehman Medical Institute, Peshawar, PAK
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26
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Lazzara C, Osorio J, Valcarcel J, Pujol-Gebellí J. Gastrointestinal Bleeding After Laparoscopic Duodenal Switch and SADI-S Caused by Pseudoaneurysm of Gastroduodenal Artery: First Reported Cases. Obes Surg 2021; 31:3330-3332. [PMID: 33754276 DOI: 10.1007/s11695-021-05358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Claudio Lazzara
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.
| | - Javier Osorio
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Joana Valcarcel
- Department of Radiology, Vascular and Interventional Radiology Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Jordi Pujol-Gebellí
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
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27
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Berek P, Kopolovets I, Dzsinich C, Bober J, Štefanič P, Sihotský V. Interdisciplinary Management of Visceral Artery Aneurysms and Visceral Artery Pseudoaneurysms. ACTA MEDICA (HRADEC KRÁLOVÉ) 2021; 63:43-48. [PMID: 32422115 DOI: 10.14712/18059694.2020.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The paper presents the results of treating 14 patients, namely eight patients with visceral artery aneurysms and six patients with visceral artery pseudoaneurysms. In 64.3% of the patients, the initial diagnosis was made based on the ultrasound examination. All the patients (100%) underwent CT angiography, while angiography was performed in 71.4% of the cases. Five (35.7%) patients with visceral artery pseudoaneurysms were emergently hospitalized; among them, the signs of bleeding were observed in 2 patients. In 9 patients, pathology was detected during tests for other conditions. Five (35.7%) patients underwent endovascular treatment, while 9 (64.3%) patients received surgical treatment. Endovascular interventions and open surgery demonstrated a nil mortality rate. After endovascular treatment, stent thrombosis was found in 1 patient. In the case of surgical treatment, visceral artery aneurysm was observed in 1 patient who underwent the resection of superior mesenteric artery pseudoaneurysm. Conclusions. The choice of the method of treating visceral artery aneurysms and visceral artery pseudoaneurysms depends on the location, size, anatomic features of the visceral arteries and the clinical course of the disease. Both endovascular and surgical treatment demonstrate good postoperative outcomes. Visceral ischemia is one of the most serious complications in the postoperative period, which can complicate both the diagnosis and the choice of treatment tactics.
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Affiliation(s)
- Peter Berek
- Clinic of Vascular Surgery, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic
| | - Ivan Kopolovets
- Clinic of Vascular Surgery, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic. .,Uzhhorod National University, Medical Faculty, Department of Surgical Diseases, Uzhhorod, Ukraine.
| | - Csaba Dzsinich
- Department of Cardiovascular and Thoracic Surgery at the National Institute of Health of Hungary, Budapest
| | - Juraj Bober
- 1st Department of Surgery, Pavol Jozef Šafárik University, Faculty of Medicine, Košice, Slovak Republic
| | - Peter Štefanič
- Clinic of Vascular Surgery, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic
| | - Vladimír Sihotský
- Clinic of Vascular Surgery, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic
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28
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Kavitha TK, Madabhavi P, Takia L, Awasthi P, Chaluvashetty SB, Aneja A, Menon P, Nallasamy K, Angurana SK, Lal S, Jayashree M. Life-threatening Upper Gastrointestinal Bleeding Due to Ruptured Gastroduodenal Artery Aneurysm in a Child. JPGN REPORTS 2021; 2:e034. [PMID: 37206949 PMCID: PMC10191588 DOI: 10.1097/pg9.0000000000000034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 05/21/2023]
Abstract
Gastroduodenal artery (GDA) aneurysm is a rare cause of massive life-threatening upper gastrointestinal (UGI) bleeding in children. Prompt resuscitation with fluids, administration of large amount of blood products (massive transfusion), prompt diagnostic evaluation using computed tomography (CT) angiography or digital subtraction angiography (DSA), and therapeutic endovascular or catheter-based interventions are life-saving. In cases with failed endovascular interventions, open surgical approach to ligate aneurysm is required. We report a 10-year-male with life-threatening UGI bleed due to ruptured GDA aneurysm possibly secondary to sepsis requiring resuscitation, massive transfusion, CT angiography and DSA, endovascular intervention, and ultimately surgical management with good outcome.
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Affiliation(s)
| | | | - Lalit Takia
- From the Pediatric Critical Care Unit, Department of Pediatrics
| | - Puspraj Awasthi
- From the Pediatric Critical Care Unit, Department of Pediatrics
| | | | | | - Prema Menon
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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29
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Yaghooti N, Memon J, Volpicelli N, Funderburk J, McCarthy D. Distress in the Duodenum: Diagnosis by Deduction. Dig Dis Sci 2021; 66:420-423. [PMID: 33464453 DOI: 10.1007/s10620-020-06758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 12/09/2022]
Affiliation(s)
- Negar Yaghooti
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131, USA.
| | - Jawairia Memon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131, USA
| | - Nicholas Volpicelli
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131, USA
| | - Jason Funderburk
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131, USA
| | - Denis McCarthy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131, USA
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30
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Sinduja R, Vijayakumar C, Sudharshan M, Kumbhar US, Naik BM, Naik D. Pseudoaneurysm of the gastroduodenal artery secondary to diverticulitis of the first part of duodenum: a rare presentation of upper gastrointestinal bleed. BMJ Case Rep 2021; 14:14/1/e238232. [PMID: 33509873 PMCID: PMC7845690 DOI: 10.1136/bcr-2020-238232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Acute upper gastrointestinal (UGI) bleeding is one of the most frequent presentations to a surgical emergency. Most of them respond to initial resuscitation, and a definite diagnosis is established as soon as possible, thereby helping the clinician in management. We present the diagnostic challenges that we faced with a 70-year-old man who presented with UGI bleed. He initially responded to resuscitation, but later deteriorated and became haemodynamically unstable. The source of the UGI bleed on evaluation was found to be pseudoaneurysm of the gastroduodenal artery (PsGDA) and treated successfully by coil embolisation. The cause of the PsGDA was diverticulum arising from the first part of duodenum with changes of diverticulitis. Diverticulum originating from the first part of the duodenum is seldom reported. Moreover, diverticulitis involving this part and causing PsGDA has not been reported so far.
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Affiliation(s)
- Ramanan Sinduja
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Mahalingam Sudharshan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Uday Shamrao Kumbhar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Bharat Manohara Naik
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Debasis Naik
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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31
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Elderly Woman With Diffuse Abdominal Pain and Shock. Ann Emerg Med 2021; 76:729-766. [PMID: 33222783 DOI: 10.1016/j.annemergmed.2020.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Indexed: 11/22/2022]
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32
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Wongwaisayawan S, Papadatos D, Aina R, Sheikh A. Ruptured Pancreaticoduodenal Artery Pseudoaneurysm in an Unusual Location in a Patient with Chronic Pancreatitis: A Case Report. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0040-1716804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractBleeding pseudoaneurysm is a rare but yet potentially lethal complication in a patient with chronic pancreatitis. It also poses a diagnostic challenge among the radiologists and the attending physicians. The mortality rate can be as high as 50% depending on the clinical status, patient hemodynamics, site, and characteristics of the bleeding pseudoaneurysm. Multidisciplinary team approach is essential to deliver the optimum treatment strategy to each individual patient. In this article, we present a case of chronic pancreatitis that presents with acute epigastric pain caused by ruptured pancreaticoduodenal artery pseudoaneurysm in an unusual location. This patient was successfully treated with transcatheter coil embolization.
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Affiliation(s)
- Sirote Wongwaisayawan
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Ratchathewi, Bangkok, Thailand
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Demetri Papadatos
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Rima Aina
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Adnan Sheikh
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
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Al Baghdadi M, Yedla P. Visceral artery aneurysm: an unusual cause of abdominal pain. BMJ Case Rep 2020; 13:13/12/e238019. [PMID: 33370948 DOI: 10.1136/bcr-2020-238019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Visceral artery aneurysms (VAAs) are uncommon with an approximate incidence of 0.01%-0.2%. Gastroduodenal artery (GDA) aneurysm is a rare subtype of these uncommon visceral aneurysms that can be fatal if ruptured. We present a case of a 58-year-old Caucasian woman with a VAA and a large haematoma arising from an actively bleeding GDA. While patients with VAA may remain asymptomatic, with some of the aneurysms found incidentally during imaging, they may also present with abdominal pain, anaemia and possible multiorgan failure which may be fatal.
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Affiliation(s)
- Maha Al Baghdadi
- Medicine, The University of Alabama at Birmingham School of Medicine Huntsville Campus, Huntsville, Alabama, USA
| | - Parekha Yedla
- Medicine, The University of Alabama at Birmingham School of Medicine Huntsville Campus, Huntsville, Alabama, USA
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Case report of a successful non-operative management of postoperative bleeding from pseudoaneurysm of the gastroduodenal artery, following gastric surgery. Int J Surg Case Rep 2020; 78:54-57. [PMID: 33310471 PMCID: PMC7736902 DOI: 10.1016/j.ijscr.2020.11.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 11/22/2022] Open
Abstract
Postoperative pseudoaneurysms occur after upper gastrointestinal operations. Almost half (52%) of the pseudoaneurysms are diagnosed when a rupture occurs. Rupture of the pseudoaneurysm can be treated by embolism of the artery. The formation of the pseudoaneurysm, occured in less than 48h as in earlier CTA the gastroduodenal artery appeared normal.
Introduction Post operative pseudoaneurysm of the gastroduodenal artery is a very rare entity. Rupture of the pseudoaneurysm can be treated by embolism of the artery. Presentation of case A 71 years old male with a perforated pyloric ulcer was treated with controlled external duodenal fistula. Due to postoperative bleeding a subtotal gastrectomy was performed. A second episode of bleeding occurred and rupture of a pseudoaneurysm of the gastroduodenal artery was diagnosed by computed angiography and treated by embolism of the artery. Three days later the duodenal stump was ruptured and a new controlled external duodenal fistula was surgically created. The patient died 6 weeks later due to multiple organ failure. Discussion Pseudoaneurysm is the result of self-contained ruptures of one or more layers of the vascular wall. Computed angiography is the golden standard to identify pseudoaneurysms (100% sensitivity). Early suspicion for the presence of a pseudoaneurysm is crucial, as when the rupture actually occurs, the mortality rate is remarkably high. Endovascular approach is a minimally invasive procedure with high success rates (70–100%) and significantly lower morbidity and mortality rates. Surgical is reserved in case of bleeding recurrence. The fact that is particularly interesting in this patient is the timing of the formation of the pseudoaneurysm, considering the fact that 48 h earlier the gastroduodenal artery appeared normal. Conclusion There are no guidelines regarding the treatment of the pseudoaneurysm of the gastroduodenal artery. It seems reasonable to treat them immediately after diagnosis because a possible rupture of the aneurysm has an extremely high mortality.
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Ahmed G, Abid M, Hosmane S, Mathew S. Unusual case of upper gastrointestinal haemorrhage secondary to a ruptured gastroduodenal artery pseudoaneurysm: case presentation and literature review. BMJ Case Rep 2020; 13:13/11/e236463. [PMID: 33229478 DOI: 10.1136/bcr-2020-236463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Pseudoaneurysm rupture of the gastroduodenal artery (GDA) is life-threatening and can present as an acute upper gastrointestinal haemorrhage. Here, we present a case of upper gastrointestinal haemorrhage arising from a ruptured GDA pseudoaneurysm. A 56-year-old woman presented acutely with haematemesis. She reported ongoing upper epigastric pain for a few weeks. Laboratory evaluation revealed severe microcytic hypochromic anaemia (haemoglobin, 69 g/L; normal, 120-140 g/L) and a mildly raised serum amylase level. Upper gastrointestinal endoscopy revealed dark blood collection between the rugae of the distal stomach. An abdominal CT scan detected a homogeneously enhancing rounded lesion arising from the GDA adjacent to the second part of the duodenum. The median arcuate ligament was causing stenosis of the coeliac axis origin. The diagnosis of haematemesis secondary to a ruptured GDA pseudoaneurysm was confirmed by mesenteric angiography, and aneurysmal embolisation was done. The haemoglobin level stabilised after aneurysmal embolisation.
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Affiliation(s)
- Gasim Ahmed
- Radiology Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Mehsim Abid
- Radiology Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Sharath Hosmane
- Radiology Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Smitha Mathew
- Radiology Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
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Macedo C, Gravito-Soares E, Gravito-Soares M. Pseudoaneurysm of the gastroduodenal artery with arterio-duodenal fistulization secondary to acute pancreatitis: an unusual endoscopic diagnosis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 113:72-73. [PMID: 33207898 DOI: 10.17235/reed.2020.7070/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Not applicable.
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Affiliation(s)
- Cláudia Macedo
- Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Portugal
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Belmir H, Tijani Y, Kettani CE, Ghanmi AE, Chtata H, Taberkant M. [Case study of ruptured gastroduodenal artery aneurysm revealed by hematemesis]. Pan Afr Med J 2020; 37:244. [PMID: 33552362 PMCID: PMC7847208 DOI: 10.11604/pamj.2020.37.244.22380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/27/2020] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Hicham Belmir
- Département de Chirurgie Vasculaire, Université Mohammed VI des Sciences de la Santé, Casablanca, Maroc
| | - Youssef Tijani
- Département de Chirurgie Vasculaire, Université Mohammed VI des Sciences de la Santé, Casablanca, Maroc
| | - Chafik El Kettani
- Département d'Anesthésie-Réanimation, Université Mohammed VI des Sciences de la Santé, Casablanca, Maroc
| | - Adil El Ghanmi
- Département de Gynécologie et Obstétrique, Université Mohammed VI des Sciences de la Santé, Casablanca, Maroc
| | - Hassan Chtata
- Département de Chirurgie Vasculaire, Université Mohammed V, Rabat, Maroc
| | - Mustapha Taberkant
- Département de Chirurgie Vasculaire, Université Mohammed V, Rabat, Maroc
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Sharma S, Prasad R, Gupta A, Dwivedi P, Mohindra S, Yadav RR. Aneurysms of pancreaticoduodenal arcade: Clinical profile and endovascular strategies. JGH Open 2020; 4:923-928. [PMID: 33102765 PMCID: PMC7578292 DOI: 10.1002/jgh3.12365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 01/09/2023]
Abstract
Background and Aim Pancreaticoduodenal arcade aneurysms (PDAAs) are uncommon lesions associated with a significant risk of rupture and mortality. This study describes the etiology, clinical presentation, and endovascular management strategies of PDAAs across a spectrum of indications. Methods The clinical records of patients with PDAAs referred for endovascular management from January 2018 till November 2019 were retrospectively reviewed. Data on presenting symptoms, associated etiologies, and outcomes after endovascular treatment were collected and studied. Results We found 15 patients with false and 1 patient with true aneurysm of pancreatoduodenal arcade (PDA). The associated conditions were coeliac artery stenosis, severe necrotizing pancreatitis, and chronic pancreatitis or iatrogenic (postendoscopic papillotomy and percutaneous metallic biliary stenting). The main presenting feature was gastrointestinal bleed, while 2 patients had abdominal pain and 1 had gastric outlet obstruction. A multiphase computed tomography scan demonstrated the ruptured aneurysm in all patients. Site of origin of PDAA influenced the choice of transarterial endovascular strategy (coiling for aneurysms of main trunk of arteries and glue injection for those arising from small arterial branches). This was carried out in an emergency setting for 12 patients and as an elective procedure in 4 patients. Technical success was demonstrated in all patients and clinical success in 14. The two patients who had rebleed were salvaged by repeat endovascular procedure. Postembolization syndrome was seen in three patients. Conclusions With advancing technology, endovascular strategies continue to evolve. Careful attention to ensure hemodynamic resuscitation and stability, correction of pre‐existing coagulopathy and attention to technique can lead to the possibility of endovascular approaches as a dependable option in the management of ruptured PDAAs.
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Affiliation(s)
- Supriya Sharma
- Department of Surgical Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Raghunanadan Prasad
- Department of Radiology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Archna Gupta
- Department of Radiology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Pranav Dwivedi
- Department of Radiology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Samir Mohindra
- Department of Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Rajanikant R Yadav
- Department of Radiology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
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Koirala A, Thapa A, Mahat S, Sapkota S, Sosa O. A Rare Case of Ruptured Bronchial Artery Pseudoaneurysm and Its Nonsurgical Management With Interventional Techniques. Cureus 2020; 12:e10502. [PMID: 33094045 PMCID: PMC7571596 DOI: 10.7759/cureus.10502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ruptured bronchial artery pseudoaneurysms with mediastinal hematoma are rare entities with a very limited number of published cases to date. The diagnosis of such cases can be difficult as the patient may present with symptoms mimicking other diseases, mainly mediastinal malignancy. A high degree of clinical suspicion and imaging techniques like contrast-enhanced computed tomography (CECT) chest and computed tomography angiography (CTA) aids in the diagnosis. Under the lights of an interventional radiologist, an urgent endovascular approach is most commonly preferred for its nonsurgical management. We present a rare case of a 47-year-old male with no previous lung disease or trauma with dyspnea and sudden onset chest pain. A massive effusion was suspected on the right side. CECT chest and digital subtraction angiography (DSA) revealed a pseudoaneurysm of a bronchial vessel with associated mediastinal hematoma, collapse of basal right lower lobe, and collection in right pleural space. This patient was later successfully treated by endovascular embolization techniques. Bronchial artery pseudoaneurysm may be considered a remote possibility in the absence of trauma or other lung diseases that may present with a massive hemothorax or mediastinal hematoma. Although CECT can be useful, digital angiography is considered the gold standard. Early intervention with the endovascular approach is a commonly recommended technique.
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Affiliation(s)
- Amrit Koirala
- Interventional Radiologist, Nepal Cancer Hospital and Research Center, Lalitpur, NPL
| | - Ajit Thapa
- Interventional Radiologist, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL
| | - Sanjay Mahat
- Radiology, Nepal Cancer Hospital and Research Center, Lalitpur, NPL
| | | | - Oscar Sosa
- Interventional Radiology, Larkin Community Hospital, Miami, USA
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40
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Taboada CR, Alonso JG, Cortés RP, Pelayo LV, Hernández PV, Sánchez FSL. Dual endovascular repair (coils and stent) of a true aneurysm of the gastroduodenal artery. J Vasc Bras 2020; 19:e20190123. [PMID: 34178066 PMCID: PMC8202159 DOI: 10.1590/1677-5449.190123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report a case of an asymptomatic gastroduodenal artery aneurysm diagnosed in a 39 year-old woman. An abdominal ultrasound study showed an aneurysmal dilatation of the gastroduodenal artery with 2 x 2 cm diameter. To confirm this finding, she then underwent a computed tomography scan of the abdomen and pelvis that showed a saccular aneurysm of the gastroduodenal artery. A dual endovascular approach was used to exclude the aneurysm by stent-assisted coil embolization. Complete exclusion of the aneurysm sac was confirmed on final angiography. She was discharged from the hospital on postoperative day 1.
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Affiliation(s)
| | | | - Rubén Peña Cortés
- Hospital Clínico de Salamanca, Angiología y Cirugía Vascular, Salamanca, España
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41
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Alam W, Kamareddine MH, Geahchan A, Ghosn Y, Feghaly M, Chamseddine A, Bou Khalil R, Farhat S. Celiacomesenteric trunk associated with superior mesenteric artery aneurysm: A case report and review of literature. SAGE Open Med Case Rep 2020; 8:2050313X20938243. [PMID: 32843965 PMCID: PMC7418225 DOI: 10.1177/2050313x20938243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/03/2020] [Indexed: 12/27/2022] Open
Abstract
In rare cases, the celiac artery and the superior mesenteric artery arise from a common origin known as a common celiacomesenteric trunk. Celiac trunk stenosis or occlusion has been reported to accompany this anatomical aberrancy. Even rarer, are aneurysms associated with this common celiacomesenteric trunk. In general, visceral artery aneurysms are uncommon. We hereby present a 39-year-old female patient with a 1-month history of mild diffuse abdominal pain, with an incidental finding of superior mesenteric artery aneurysm on abdominal ultrasound. Subsequent contrast-enhanced computed tomography revealed severe narrowing of the celiac trunk and saccular aneurysmal dilatation of the superior mesenteric artery. Coil embolization of the aneurysm was performed, while maintaining persistent flow in the superior mesenteric artery and celiacomesenteric trunk. Visceral artery aneurysms are increasingly being identified incidentally with improvement in imaging techniques. The question lies whether to treat these aneurysms or observe. No universal guidelines exist regarding that matter, but the decision to intervene is made based on aneurysm location, size, and patient characteristics.
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Affiliation(s)
- Walid Alam
- Department of Internal Medicine, Saint George Hospital University Medical Center, Beirut, Lebanon
| | | | - Amine Geahchan
- Department of Radiology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Youssef Ghosn
- Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Michel Feghaly
- Department of Vascular Surgery, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Abbas Chamseddine
- Department of Interventional Radiology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Rola Bou Khalil
- Department of Endocrinology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Said Farhat
- Department of Gastroenterology, Saint George Hospital University Medical Center, Beirut, Lebanon
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Chang D, Patel P, Persky S, Ng J, Kaell A. Management of Gastroduodenal Artery Pseudoaneurysm Rupture With Duodenal Ulcer Complicated by Coil Migration. ACG Case Rep J 2020; 7:e00347. [PMID: 32548184 PMCID: PMC7224706 DOI: 10.14309/crj.0000000000000347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/13/2020] [Indexed: 11/28/2022] Open
Abstract
Rupture of visceral artery aneurysms or visceral artery pseudoaneurysms is an unusual cause of upper gastrointestinal bleeding. Although most visceral artery aneurysms and visceral artery pseudoaneurysms occur in the splenic artery or hepatic artery, they can rarely occur in the gastroduodenal artery. These are at high risk for rupture, with a 40%-70% mortality. We report a case of recurrent upper gastrointestinal bleeding due to gastroduodenal artery pseudoaneurysm despite endoscopic treatment and endovascular embolization complicated by coil migration into the duodenum.
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Affiliation(s)
- Dennis Chang
- Department of Internal Medicine, Internal Medicine at Northwell Health at Mather Hospital, Port Jefferson, NY
| | - Purvi Patel
- Department of Internal Medicine, Internal Medicine at Northwell Health at Mather Hospital, Port Jefferson, NY
| | - Seth Persky
- Department of Gastroenterology, Long Island Digestive Disease Consultants, Setauket, NY
| | - Joseph Ng
- Department of Internal Medicine, Internal Medicine at Northwell Health at Mather Hospital, Port Jefferson, NY
| | - Alan Kaell
- Department of Internal Medicine, Internal Medicine at Northwell Health at Mather Hospital, Port Jefferson, NY
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43
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Sgantzou IK, Samara AA, Diamantis A, Karagiorgas GP, Zacharoulis D, Rountas C. Pseudoaneurysm of gastroduodenal artery and pulmonary embolism: rare co-incidence of two complications of pancreatitis. J Surg Case Rep 2020; 2020:rjz407. [PMID: 32104567 PMCID: PMC7033481 DOI: 10.1093/jscr/rjz407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 12/19/2019] [Indexed: 01/11/2023] Open
Abstract
Preventing and curing complications of acute and chronic pancreatitis, which may be local or systemic, remains a challenge. Pseudocysts and walled-off pancreatic necrosis are two local complications that most frequently require surgical intervention. Two rare complications of pancreatitis are pseudoaneurysms and pulmonary embolism. Angiographic embolization can be the treatment of choice for pseudoaneurysms, while for pulmonary embolism apart from anticoagulation treatment, the optional inferior vena cava filter placement could be useful. As far as we know, in literature, these complications of pancreatitis have never been reported simultaneously yet.
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Affiliation(s)
| | - Athina A Samara
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | | | | | | | - Christos Rountas
- Department of Interventional Radiology, University Hospital of Larissa, Larissa, Greece
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44
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Casas ALF, Camargo MPDF, Moisés CB, Trad HS, Joviliano EE. Endovascular treatment of gastroduodenal artery aneurysm: case report. J Vasc Bras 2019; 18:e20190019. [PMID: 31798642 PMCID: PMC6869645 DOI: 10.1590/1677-5449.190019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Gastroduodenal artery aneurysm is a disease with low incidence that manifests in a nonspecific form in the majority of cases, which hinders initial diagnosis. Symptomatic cases may present with abdominal pains or hemorrhage secondary to rupture. In cases in which the aneurysm ruptures, prognosis is poor and mortality can reach 40%. Steps should therefore be taken to ensure early diagnosis and treatment. Although open surgical treatment is an option, over recent years there has been a growing trend to use endovascular techniques. This report describes a rare case of a young patient with a gastroduodenal artery who was successfully treated with endovascular techniques.
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Affiliation(s)
| | | | | | - Henrique Simão Trad
- Universidade de São Paulo - USP, Campus de Ribeirão Preto, Ribeirão Preto, SP, Brasil
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45
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Binetti M, Lauro A, Golfieri R, Vaccari S, D'Andrea V, Marino IR, Cervellera M, Renzulli M, Tonini V. False in Name Only-Gastroduodenal Artery Pseudoaneurysm in a Recurrently Bleeding Patient: Case Report and Literature Review. Dig Dis Sci 2019; 64:3086-3091. [PMID: 31559552 DOI: 10.1007/s10620-019-05853-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Although the diagnosis of visceral pseudoaneurysm is unusual, it requires emergent attention due to the risk of rupture. We describe a 70-year-old man with a gastroduodenal artery pseudoaneurysm that manifested as recurrent hemorrhage. We highlight the possible etiologies, clinical presentations, diagnostic tools, and treatment options for this condition. In this instance, the patient was successfully treated by selective angioembolization. A visceral pseudoaneurysm should be considered in patients with abdominal pain and GI hemorrhage. At present, angioembolization is a first-line therapy.
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Affiliation(s)
- M Binetti
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | - A Lauro
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy.
| | - R Golfieri
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, St. Orsola University Hospital, Bologna, Italy
| | - S Vaccari
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | - V D'Andrea
- Department of Surgical Sciences, La Sapienza University, Umberto I Hospital, Rome, Italy
| | - I R Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Cervellera
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | - M Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, St. Orsola University Hospital, Bologna, Italy
| | - V Tonini
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
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46
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Current management strategies for visceral artery aneurysms: an overview. Surg Today 2019; 50:38-49. [PMID: 31620866 PMCID: PMC6949316 DOI: 10.1007/s00595-019-01898-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/28/2019] [Indexed: 12/16/2022]
Abstract
Visceral artery aneurysms (VAAs) are rare and affect the celiac artery, superior mesenteric artery, and inferior mesenteric artery, and their branches. The natural history of VAAs is not well understood as they are often asymptomatic and found incidentally; however, they carry a risk of rupture that can result in death from hemorrhage in the peritoneal cavity, retroperitoneal space, or gastrointestinal tract. Recent advances in imaging technology and its availability allow us to diagnose all types of VAA. VAAs can be treated by open surgery, laparoscopic surgery, endovascular therapy, or a hybrid approach. However, there are still no specific indications for the treatment of VAAs, and the best strategy depends on the anatomical location of the aneurysm as well as the clinical presentation of the patient. This article reviews the literature on the etiology, clinical features, diagnosis, and anatomic characteristics of each type of VAA and discusses the current options for their treatment and management.
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47
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Sousa J, Costa D, Mansilha A. Visceral artery aneurysms: review on indications and current treatment strategies. INT ANGIOL 2019; 38:381-394. [DOI: 10.23736/s0392-9590.19.04194-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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48
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Saran M, Biswas S. A Rare Case of Jejunal Pseudoaneurysm Presenting as Acute Small Bowel Obstruction After Blunt Trauma: Discussion, Management Dilemmas, and a Review of Relevant Literature. Cureus 2019; 11:e5655. [PMID: 31700756 PMCID: PMC6822550 DOI: 10.7759/cureus.5655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPAs) are often found incidentally through imaging of a patient presenting with vague symptoms of abdominal pain, hematochezia, hematemesis, and melena. Due to the asymptomatic nature, the etiology is often unknown. However, suspicion for VAA and VAPA should remain high for those presenting with symptoms listed above after trauma or pancreatitis. Here we discuss a case of traumatic ileocolic pseudoaneurysm that has only been discussed a handful of times in the literature.
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Affiliation(s)
- Manick Saran
- Miscellaneous, Lake Erie College of Osteopathic Medicine, Erie, USA
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49
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Iannamorelli M, Bowling A, Semaan E. Eroded GDA coil surgically managed with Roux-en-Y reconstruction. J Surg Case Rep 2019; 2019:rjz234. [PMID: 31462983 PMCID: PMC6705449 DOI: 10.1093/jscr/rjz234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 12/03/2022] Open
Abstract
Here, we describe the case of a 56-year-old African American male who initially presented to the emergency department with 2 days of abdominal cramping, epigastric pain, loss of consciousness, melena and hematochezia. He underwent coil embolization of his gastroduodenal artery by the interventional radiology team after it was felt he was a high risk for rebleed. The patient then returned to the hospital with 3 weeks of epigastric pain, lightheadedness and melanotic stool. An upper endoscopy revealed a metallic coil embedded into the duodenal bulb. This coil was believed to be from prior embolization to the gastroduodenal artery. The patient then underwent a laparoscopic distal gastrectomy and partial duodenectomy with antecolic antegastric Roux-en-Y reconstruction bypassing the area where erosion occurred.
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Affiliation(s)
- Michael Iannamorelli
- Department of Surgery, Berkshire Medical Center, 725 North St., Pittsfield MA 01201, USA
| | - Adam Bowling
- Department of Surgery, Berkshire Medical Center, 725 North St., Pittsfield MA 01201, USA
| | - Elie Semaan
- Department of Surgery, Berkshire Medical Center, 725 North St., Pittsfield MA 01201, USA
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Desai GS, Pande PM. Gastroduodenal artery: single key for many locks. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2019; 26:281-291. [PMID: 31099488 DOI: 10.1002/jhbp.636] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gastroduodenal artery (GDA) commonly arises from common hepatic artery, a branch of celiac axis. It holds a unique anatomical position that connects the foregut and midgut due to its intimate communications with foregut and midgut arterial supply. Its numerous anatomical variations have a significant impact on planning and performance of hepatopancreaticobiliary (HPB) surgery. Its close relation to the first part of duodenum, common bile duct and head of pancreas makes it susceptible for inadvertent bleeding during or after surgery, or due to various HPB pathologies. Also, a large number of vascular interventions rely on GDA and its branches. Careful preoperative planning is the key and a detailed knowledge and awareness of its variant anatomy is of paramount importance, be it liver resections, liver transplant, biliary and pancreatic resections and pancreatic transplant or transarterial procedures involving these arteries. GDA can also be a cause of gastrointestinal hemorrhage due to true or pseudoaneurysms and anatomy has significant implications on its management. The article provides a succinct review on relevance of GDA anatomy and variations and highlights that preoperative planning and intraoperative awareness of variations is the key to performance of safe HPB surgery and interventions.
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Affiliation(s)
- Gunjan S Desai
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Center, Mumbai, Maharashtra, India
| | - Prasad M Pande
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Center, Mumbai, Maharashtra, India
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