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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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2
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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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3
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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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4
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Zarin M, Ali S, Majid A, Jan Z. Gastroduodenal artery aneurysm - Post traumatic pancreatic pseudocyst drainage - An interesting case. Int J Surg Case Rep 2017; 42:82-84. [PMID: 29227856 PMCID: PMC5726880 DOI: 10.1016/j.ijscr.2017.11.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/26/2017] [Accepted: 11/28/2017] [Indexed: 01/17/2023] Open
Abstract
Pseudo aneurysms of gastroduodenal artery (GDA) are rare. They mostly have an association with pancreatitis. Rupture of the GDA can present with GI hemorrhage, however, they may present late following gastric or pancreatic surgery or trauma as melena. They are potentially fatal if they rupture. Hence, early diagnosis and prompt treatment is necessary. Intervention radiology has a key role in the management of rupture of GDA aneurysm. CT Angiography is the investigation of choice. And Angioembolization is the preferred treatment modality.
Background and aim Pseudoaneurysms of the gastroduodenal artery (GDA) are rare and mostly associated with pancreatitis. However, they can occur as a possible complication following gastric or pancreatic surgery and thus prior recognition and prompt treatment is mandatory (Lee et al., 2009 [1]). We report a case of a ruptured GDA aneurysm in a patient who underwent roux-en-y-cystojejunostomy for traumatic pancreatic pseudocyst and this has rarely been reported in the literature. Our patient presented with melena one month post operatively. CT Angiogram showed pseudoaneurysm of the GDA and the origin of right gastroepiploic artery which was embolised. Our case highlights that GDA aneurysm must be considered in the differential for a patient who presents with melena following drainage of traumatic pancreatic pseudocyst and that it can be managed successfully with angioembolization. Case presentation A young boy was operated for traumatic pancreatic pseudocyst. One month later, he presented with the complaints of melena. Patient was resuscitated initially and then CT Angiogram was planned that showed pseudo aneurysm of the GDA and the origin of right gastroepiploic artery. The aneurysm was embolised and patient was sent home later on. On two months follow up the patient was doing well and had no episode of melena. Conclusion GDA aneurysm are rare and should be suspected in a patient with GI hemorrhage after surgery for traumatic pancreatic pseudocyst. The investigation of choice is CT Angiography and endovascular angioembolization is the treatment modality of choice.
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Affiliation(s)
| | - Sajid Ali
- Khyber Teaching Hospital Peshawar, 25120, Pakistan.
| | - Abdul Majid
- Khyber Teaching Hospital Peshawar, 25120, Pakistan.
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5
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Huang CF, Liu YT, Wu YC, Bai YM, Yeh YH, Hung TY. Spontaneous pseudoaneurysm rupture of gastroduodenal artery: a rare and life-threatening condition of back pain. J Formos Med Assoc 2014; 113:756-757. [PMID: 25240305 DOI: 10.1016/j.jfma.2012.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 08/30/2012] [Accepted: 08/31/2012] [Indexed: 06/03/2023] Open
Affiliation(s)
- Chang-Feng Huang
- Emergency Department, Zhongxing Branch of Taipei City Hospital, Taiwan
| | - Yin-Tzu Liu
- Ophthalmology Department, Zhudong Veterans Hospital, Taiwan
| | - Yi-Ching Wu
- Emergency Department, Zhongxing Branch of Taipei City Hospital, Taiwan
| | - Yu-Ming Bai
- Emergency Department, Zhongxing Branch of Taipei City Hospital, Taiwan
| | - Yu-Hang Yeh
- Emergency Department, Zhongxing Branch of Taipei City Hospital, Taiwan
| | - Tzu-Yao Hung
- Emergency Department, Zhongxing Branch of Taipei City Hospital, Taiwan.
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Nicolini A, Gaia G, Duiella SF, Ossola MW, Fedele L. Conservative treatment of giant uterine artery pseudoaneurysm. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:602-604. [PMID: 24659469 DOI: 10.1002/uog.13370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 03/07/2014] [Accepted: 03/14/2014] [Indexed: 06/03/2023]
Affiliation(s)
- A Nicolini
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Fukatsu K, Ueda K, Maeda H, Yamashita Y, Itonaga M, Mori Y, Moribata K, Shingaki N, Deguchi H, Enomoto S, Inoue I, Maekita T, Iguchi M, Tamai H, Kato J, Ichinose M. A case of chronic pancreatitis in which endoscopic ultrasonography was effective in the diagnosis of a pseudoaneurysm. World J Gastrointest Endosc 2012; 4:335-8. [PMID: 22816016 PMCID: PMC3399014 DOI: 10.4253/wjge.v4.i7.335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 04/26/2012] [Accepted: 05/27/2012] [Indexed: 02/05/2023] Open
Abstract
Endoscopic ultrasonography (EUS) was performed on a patient being treated for chronic pancreatitis because a submucosal tumor was observed in the stomach during gastrointestinal endoscopy. As internal pulsatile blood flow on Doppler was present, the diagnosis of an aneurysm was made. The pseudoaneurysm of the left gastric artery was embolized with histoacryl and lipiodol and the splenic artery was embolized with coils at the location of the pseudoaneurysm to prevent hemorrhage. Follow up EUS confirmed the cessation of blood flow from the pseudoaneurysm. Clinicians encountering a gastric submucosal tumor-like protrusion in a patient with chronic pancreatitis should use EUS to investigate the possibility of a pseudoaneurysm, which must be treated as quickly as possible once identified.
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Affiliation(s)
- Kazuhiro Fukatsu
- Kazuhiro Fukatsu, Kazuki Ueda, Hiroki Maeda, Yasunobu Yamashita, Masahiro Itonaga, Yoshiyuki Mori, Kosaku Moribata, Naoki Shingaki, Hisanobu Deguchi, Shotaro Enomoto, Izumi Inoue, Takao Maekita, Mikitaka Iguchi, Hideyuki Tamai, Jun Kato, Masao Ichinose, Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan
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