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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] [What about the content of this article? (0)] [Affiliation(s)] [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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2
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Shimizu S, Matsunaga T, Sakano Y, Makinoya M, Shishido Y, Miyatani K, Kono Y, Murakami Y, Hanaki T, Kihara K, Yamamoto M, Tokuyasu N, Takano S, Sakamoto T, Hasegawa T, Fujiwara Y. A gastroduodenal artery that branched from the celiac artery in gastrectomy: A rare case of an anatomical variant. Asian J Endosc Surg 2024; 17:e13268. [PMID: 38093466 DOI: 10.1111/ases.13268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/31/2023] [Accepted: 11/23/2023] [Indexed: 01/13/2024]
Abstract
Understanding anatomical anomalies of the branch of the celiac artery for safe gastrectomy is important. We report a case of laparoscopic distal gastrectomy with D1+ lymph node dissection for early gastric cancer with a vascular anatomical anomaly of the celiac artery. A 45-year-old woman was referred to our hospital because of early gastric cancer. Computed tomography showed an anatomical variation of the gastroduodenal artery, which branched from the celiac artery. The celiac artery also branched into the left gastric artery, the splenic artery, and the common hepatic artery. Preoperative understanding of an unusual branch of the celiac artery enabled a safe laparoscopic surgery. There were no postoperative complications. The Adachi classification or Michel classification is used for an anatomical anomaly of the celiac artery, but to the best of our knowledge, this case has not been previously classified and is the first reported case.
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Affiliation(s)
- Shota Shimizu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Yu Sakano
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Masahiro Makinoya
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Yuji Shishido
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Yusuke Kono
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Yuki Murakami
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Takehiko Hanaki
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Kyoichi Kihara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Naruo Tokuyasu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Shuichi Takano
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Toshimichi Hasegawa
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
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Ostrowski P, Bonczar M, Gliwa J, Clarke K, Datta T, Iskra T, Pasternak A, Wojciechowski W, Walocha J, Koziej M. The arterial anatomy of the posterior duodenum - A computed tomography angiography analysis with implications for abdominal surgery. Clin Anat 2023; 36:1116-1126. [PMID: 36994833 DOI: 10.1002/ca.24043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/20/2023] [Accepted: 03/29/2023] [Indexed: 03/31/2023]
Abstract
The main objective of the present study was to clarify the anatomical characteristics of the GDA. In order to fulfill this objective, novel classification systems of both the origin and branching pattern of the said vessel were created. Being aware of the variable anatomy of the GDA is of great importance when performing hepatopancreaticobilliary procedures. The results of 75 consecutive patients who underwent abdomen computed tomography angiography (CTA) were analyzed. A total of 74 GDA were analyzed. Of these, 42 were from women (56.8%) and 32 were from men (43.2%). The most common direction of origin of the GDA was inferior (n = 38; 51.4%). The origin variation of each GDA was deeply analyzed. Initially, eight types of origin variations were evaluated, of which types 1-3 constituted 83.8%. Furthermore, analogously, branching pattern types were also established. Initially, 11 branching variations were evaluated, of which types 1-3 constituted 87.8%. The GDA is subject to numerous variations, both in the origin and in the branching pattern of the vessel. In order to clarify the anatomical characteristics of this vessel, novel classifications of the origin and branching patterns were made, presenting the most frequent patterns. Our results may be of great use for surgeons performing hepatopancreaticobilliary surgeries, such as the Whipple procedure or vascular reconstructions after cholangiocarcinoma resections. Being aware of the anatomical variations of relevant structures associated with a surgical procedure may help reduce potential intraoperative and/or postoperative complications.
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Affiliation(s)
- Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Jakub Gliwa
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Kelsey Clarke
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Tanisha Datta
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Iskra
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Artur Pasternak
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Wadim Wojciechowski
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Fiske H, Dougherty B, Ward C, Claus J, Dannheim K, Chen S, Ferreira J. Not Your Everyday Duodenal Ulcer: Massive Gastrointestinal Bleed Secondary to Extramedullary Plasma Cell Myeloma. ACG Case Rep J 2023; 10:e01040. [PMID: 37091203 PMCID: PMC10118377 DOI: 10.14309/crj.0000000000001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
The differential for gastrointestinal (GI) bleeding is broad, ranging from peptic ulcers and Helicobacter pylori infection to variceal hemorrhage and neoplasms. The rarer causes of GI bleeds are frequently overlooked and as such can ultimately be more dangerous. Extramedullary multiple myeloma, an atypical plasma cell dyscrasia arising outside of the bone marrow, involves the GI tract in <5% of cases and often presents with nonspecific symptoms. We describe a rare case of such GI involvement of a plasma cell tumor, with subsequent transmural duodenal ulceration involving the gastroduodenal artery, ultimately resulting in a fatal GI bleed.
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Affiliation(s)
- Hannah Fiske
- Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| | - Brian Dougherty
- Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| | - Christopher Ward
- Division of Gastroenterology, Lahey Hospital and Medical Center, Burlington, MA
| | - Jessica Claus
- Department of Pathology, Warren Alpert Medical School, Brown University, Providence, RI
| | - Katelyn Dannheim
- Department of Pathology, Warren Alpert Medical School, Brown University, Providence, RI
| | - Sonja Chen
- Department of Pathology, Nationwide Children's Hospital, Columbus, OH
| | - Jason Ferreira
- Division of Gastroenterology, Warren Alpert Medical School, Brown University, Providence, RI
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6
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Shibata E, Takao H, Abe O. N-butyl-2-cyanoacrylate Packing of a Gastroduodenal Artery Pseudoaneurysm due to Distal Pancreatectomy After Subtotal Esophagectomy. Vasc Endovascular Surg 2023:15385744231165207. [PMID: 36924267 DOI: 10.1177/15385744231165207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
We describe the successful n-butyl cyanoacrylate (NBCA) packing of a large gastroduodenal artery pseudoaneurysm after distal pancreatectomy in a patient with a history of subtotal esophagectomy and gastric tube reconstruction. The pseudoaneurysm was considered to be caused by direct injury to the gastroduodenal artery (GDA). However, embolization of the GDA was not possible in this case because due to prior esophageal surgery, the main blood vessel supplying the gastric tube was the right epigastric artery from the GDA. Packing a pseudoaneurysm with NBCA is a treatment option when preservation of the parent artery is required.
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Affiliation(s)
- Eisuke Shibata
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidemasa Takao
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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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] [What about the content of this article? (0)] [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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8
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Jeon JB, Lee KS, Lee CH, Jung Y, Jeong IS, Song SY, Oh SG, Na KJ. Differentiation of multiple visceral artery aneurysm rupture from major bleeding after coronary artery bypass grafting. J Card Surg 2022; 37:1428-1430. [PMID: 35192213 DOI: 10.1111/jocs.16354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/05/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Visceral artery aneurysm is a very rare disease, but it is clinically important because of the high risk of rupture involved. These ruptures must be differentiated from those that occur during hospitalization after extra-abdominal surgery. METHODS During hospitalization after off-pump coronary artery bypass grafting, a 77-year-old woman developed hypovolemic symptoms and had decreased hemoglobin. There was no obvious bleeding, but while screening for possible complications after cardiac surgery, abdominal computed tomographic angiography showed multiple visceral artery aneurysms of the gastroduodenal and pancreaticoduodenal arteries along with hemoperitoneum. RESULTS The patient underwent coil embolization of the visceral artery aneurysm and was discharged without any complications. CONCLUSIONS In patients with coronary artery disease with risk factors for atherosclerosis, if anemia occurs without apparent bleeding after surgery, visceral artery aneurysm should be considered as a differential diagnosis.
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Affiliation(s)
- Jae B Jeon
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Kyo S Lee
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Cho H Lee
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Yochun Jung
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - In S Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Sang Y Song
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Sang G Oh
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Kook J Na
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Zuhaili B, Molnar RG, Malhotra NG. The endovascular management of a 3.5-cm gastroduodenal artery aneurysm presenting with gastritis and recurrent pancreatitis. Avicenna J Med 2021; 7:130-132. [PMID: 28791247 PMCID: PMC5525468 DOI: 10.4103/ajm.ajm_3_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Visceral artery aneurysms (VAAs) are a rare entity. Within this subset of aneurysms, gastroduodenal artery (GDA) aneurysms represent an even more rare occurrence. We present a case report of treating GDA aneurysm on semi-elective basis followed by literature review of the clinical presentation and mainstream treatment modalities. GO is a 65-year-old male, with 6-month history of recurrent epigastric pain. He was found to have acute pancreatitis and an adjacent 3.5-cm GDA aneurysm. After conservative treatment of pancreatitis, the aneurysm was treated with coil embolization of the sac and GDA. Most VAAs are asymptomatic; GDA aneurysms tend to present clinically with epigastric pain or pancreatitis. In addition, together with pancreaticoduodenal aneurysms, GDA aneurysms warrant immediate intervention once diagnosed. Open surgical options for VAAs include aneurysm resection with or without revascularization (i.e., bypass), aneurysm ligation, or end-organ resection (i.e., splenectomy). Endovascular repair involves coil embolization with or without stent placement. While endovascular modality continues to be the first choice for stable elective VAA patients, modality of treatment for ruptured VAA or unstable patients will vary according to the patient's overall status, operator's experience, and institute capacity.
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Affiliation(s)
- Baraa Zuhaili
- Michigan Vascular Center, McLaren Regional Hospital, Michigan State University, Flint, MI, USA
| | - Robert G Molnar
- Michigan Vascular Center, McLaren Regional Hospital, Michigan State University, Flint, MI, USA
| | - Nitin G Malhotra
- Michigan Vascular Center, McLaren Regional Hospital, Michigan State University, Flint, MI, USA
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12
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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13
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Imam A, Karatas C, Mecit N, K A, Yildirimoglu T, Kalayoglu M, Kanmaz T. Anatomical variations of the hepatic artery: a closer view of rare unclassified variants. Folia Morphol (Warsz) 2021. [PMID: 33749803 DOI: 10.5603/FM.a2021.0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Defining the hepatic artery anatomy is of great importance for both surgeons and radiologists. Michel classification was designed to classify hepatic artery variations. Nevertheless, there are variations that do not fit into this classification. In this study, we aim to define the incidence of all variations in a healthy liver donor by reviewing their CT scan with special emphasis on variations that do not fit in any of the Michel classes. MATERIALS AND METHODS A retrospective analysis of CT scan of donors and potential liver donors who were evaluated by triphasic CT scan. The CT scans were reviewed independently by a radiologist and two transplant surgeons. Cases that did not fit in any of the Michel classes were classified as class 0. RESULTS Out of 241 donors, 210 were classified within the Michel classification, of which 60.9 % were class I and 9.1% class II. Thirty-one donors (12.9%) classified as class 0. Of which, nine, three, two and three had replaced right hepatic artery from pancreaticoduodenal artery, gastroduodenal artery, aorta and celiac artery, respectively. Two and 6 donors had accessory right hepatic artery from pancreaticoduodenal artery and gastroduodenal artery respectively. Segment 4 artery originated from left and right hepatic artery in 56.8% and 31.9%, respectively. CONCLUSIONS A great caution should be taken when evaluating the hepatic artery anatomy, clinicians should anticipate and be familiar with the rare unclassified variations of the hepatic artery.
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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 Rep 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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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17
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Ekingen A, Tuncer MC, Ertuğrul Ö. Investigation of proper hepatic artery and gastroduodenal artery variations by multidetector computed tomography angiography method. Acta Chir Belg 2020; 120:102-115. [PMID: 30714485 DOI: 10.1080/00015458.2019.1570744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: The purpose of this study is to evaluate the clinical anatomic variations of the proper hepatic artery (PHA) and the gastroduodenal artery (GDA). For this purpose, angiographic images of patients were evaluated.Materials and methods: We retrospectively reviewed the multiple-detector computed tomography angiography images of 671 patients.Results: In this retrospective study, 35 different types were identified as associated with PHA and GDA. There were 292 patients (43.52%; 175 females and 117 males) included in normal anatomical classification. Different anatomic variations were detected in 300 patients (44.71%; 129 females and 171 males). In 79 patients, arterial branch follow-up failed. These patients were evaluated as an unidentified group.Conclusion: We described different vascular variations in the PHAs and GDAs of our patients.
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Affiliation(s)
- Arzu Ekingen
- Vocational School of Health Services, University of Batman, Batman, Turkey
| | - Mehmet Cudi Tuncer
- Department of Anatomy Faculty of Medicine, University of Dicle, Diyarbakır, Turkey
| | - Özgür Ertuğrul
- Department of Radiology, Memorial Hospital, Diyarbakır, Turkey
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18
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Klimopoulos S, Charakopoulou A, Pantelis A, Bouchagier K. Embedment of the gastroduodenal artery stump into the jejunal serosa: A new technique aiming to prevent post-pancreatectomy hemorrhage. J Popul Ther Clin Pharmacol 2019; 26:e32-6. [PMID: 31909574 DOI: 10.15586/jptcp.v26i4.652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 11/21/2019] [Indexed: 01/08/2023]
Abstract
Post-pancreaticoduodenectomy hemorrhage has an estimated incidence of 5% and a mortality rate of 11-38%. Vascular erosion resulting from pancreatic leak and skeletonization of the arterial wall during pancreatic mobilization may be the two possible mechanisms responsible for this complication, which most commonly affects the gastroduodenal artery stump. A novel technique of wrapping up the gastroduodenal artery stump into the jejunal serosa to decrease postoperative hemorrhage is presented.
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19
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Yaseen S, Wadhwa S, Jeelani K, Mahajan A, Mishra S. Abnormal Persistence of Embryonic Blood Supply of Liver: Anatomist's Delight, Surgeon's Nightmare. Acta Medica (Hradec Kralove) 2019; 62:72-76. [PMID: 31362814 DOI: 10.14712/18059694.2019.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The high incidence of hepato-biliary vascular anatomy variations necessitates its evaluation prior to performing liver transplantation, hepatobiliary, pancreatic, gastric and oesophageal surgeries. We report a unique case of persistence of embryonic arteries of the liver, wherein, the liver was supplied by five vessels. In addition to the usual right and left hepatic arteries from the hepatic artery proper, the liver received two accessory right hepatic arteries, one from the gastroduodenal artery, while another arising from superior mesenteric artery and an accessory left hepatic artery, from the left gastric artery. The origin of gastroduodenal artery was found to be unusually high and its abnormal anterior course over the common bile duct further added complexity to the hepatobiliary anatomy. The presence of these aberrant and accessory arteries predisposes to inadvertent injury leading to patient morbidity and sometimes mortality.
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Affiliation(s)
- Sabah Yaseen
- Department of Anatomy, Maulana Azad Medical College, New Delhi, India
| | - Surbhi Wadhwa
- Department of Anatomy, Maulana Azad Medical College, New Delhi, India.
| | - Kahkashan Jeelani
- Department of Anatomy, Maulana Azad Medical College, New Delhi, India
| | - Anita Mahajan
- Department of Anatomy, Maulana Azad Medical College, New Delhi, India
| | - Sabita Mishra
- Department of Anatomy, Maulana Azad Medical College, New Delhi, India
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20
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Miyahara K, Hoshina K, Nitta J, Kimura M, Yamamoto S, Ohshima M. Hemodynamic Simulation of Pancreaticoduodenal Artery Aneurysm Formation Using an Electronic Circuit Model and a Case Series Analysis. Ann Vasc Dis 2019; 12:176-181. [PMID: 31275470 PMCID: PMC6600102 DOI: 10.3400/avd.oa.19-00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess mechanisms underlying aneurysm formation using a simple electronic circuit model. Materials and Methods: We created a simple circuit model connecting the celiac artery (CA) to the superior mesenteric artery via the pancreaticoduodenal arcade. We retrospectively reviewed 12 patients with true pancreaticoduodenal artery aneurysms (PDAAs) who received open or endovascular treatment between 2004 and 2017. We set the resistance of each artery and organ voltage and calculated flow volume and rate in response to degrees of simulated CA stenosis from 0% to 99.9%. Results: Flow volume rates of the anterior pancreaticoduodenal artery and posterior pancreaticoduodenal artery decreased to zero when CA stenosis increased from 0% to 50% and then increased drastically, at which point flow direction reverted and the flow was up to three times the initial rate. The gastroduodenal artery (GDA) also showed reversed flow with severe CA stenosis. In 12 patients with PDAA, eight presented with a CA lesion, and the other patients presented with comorbidities causing the arteries to be pathologically fragile, such as Marfan syndrome, Behçet’s disease, and segmental arterial mediolysis. All four GDA aneurysms were not accompanied by CA lesions. Conclusion: The mechanism underlying CA-lesion-associated PDAA formation may be partially explained using our model.
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Affiliation(s)
- Kazuhiro Miyahara
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuyuki Hoshina
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jun Nitta
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaru Kimura
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sota Yamamoto
- Department of Mechanical Engineering, Graduate School, Shibaura Institute of Technology, Tokyo, Japan
| | - Marie Ohshima
- Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
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21
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Abstract
Visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPAs) are defined as more than a 1.5 fold increase in the normal diameter of the celiac, superior, or inferior mesenteric arteries and their branches. They represent a rare finding with an incidence ranging between 0.1% to 0.2%. Depending on the mechanism of formation, aneurysms can be divided into true aneurysms or pseudoaneurysms. True aneurysms involve all layers of the wall, which are usually thinned but remain intact and commonly result from vessel wall abnormalities. However, pseudoaneurysms occur after vascular injuries or nearby inflammatory process causing a tear in the vessel wall. Pancreatitis is the most common cause of pseudoaneurysm. Nevertheless, other conditions, such as autoimmune disorders, vascular interventions, laparoscopic cholecystectomy, and even hepatic transplantation, have been reported to increase the risk of pseudoaneurysm formation. Herein, we are reporting a case of a gastroduodenal artery pseudoaneurysm rupture in a patient with altered anatomy secondary to Billroth II surgery.
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Affiliation(s)
- Zeinab Awada
- Internal Medicine, Lebanese American University-Medical Center, Beirut, LBN
| | - Hassan Al Moussawi
- Internal Medicine, Staten Island University Hospital, Staten Island, USA
| | - Mira Alsheikh
- Internal Medicine, Staten Island University Hospital, Staten Island, USA
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22
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Bahl B, Vadlamudi R, Yedla P, Smalligan RD. 'Bleeding Dilemma': The Story of a Periampullary Mass. Cureus 2018; 10:e3035. [PMID: 30254824 PMCID: PMC6150752 DOI: 10.7759/cureus.3035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/22/2018] [Indexed: 11/29/2022] Open
Abstract
Periampullary malignancies arise in the vicinity of the ampulla of Vater, a common passage for biliary and pancreatic secretions. Determining the anatomical origin of these tumors represents a diagnostic challenge. This is especially true for large tumors due to the transitional nature of this region, proximity to different structures, anatomical variations, and overlapping features among constituting structures. This determination has significant prognostic and therapeutic implications. Among them, primary ampullary adenocarcinoma is a rare malignancy that has the best overall prognosis with high rates of potentially curative resection and possible survival even in advanced disease. Due to its rarity, it is also a vague territory with no definitive guidelines regarding management and surveillance currently available. Acute gastrointestinal hemorrhage is a rare presentation of ampullary carcinoma that occurs secondary to tumor ulceration. We report an elderly male with a previously known large, initially asymptomatic periampullary mass who came for evaluation of melena and was noted to be hypotensive secondary to acute blood loss from the large tumor, later determined to be adenocarcinoma of the ampulla of Vater.
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Affiliation(s)
- Bhavyaa Bahl
- UAB Internal Medicine, Huntsville Regional Medical Campus, Huntsville Hospital, Huntsville, USA
| | - Rohith Vadlamudi
- UAB School of Medicine, Huntsville Regional Medical Campus, Huntsville Hospital, Huntsville, USA
| | - Parekha Yedla
- UAB Internal Medicine, Huntsville Regional Medical Campus, Huntsville Hospital, Huntsville , USA
| | - Roger D Smalligan
- UAB Medicine, Huntsville Regional Medical Campus, Huntsville Hospital, Huntsville, USA
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23
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Kuyumcu G, Latich I, Hardman RL, Fine GC, Oklu R, Quencer KB. Gastrodoudenal Embolization: Indications, Technical Pearls, and Outcomes. J Clin Med 2018; 7:jcm7050101. [PMID: 29724061 PMCID: PMC5977140 DOI: 10.3390/jcm7050101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 01/06/2023] Open
Abstract
The gastroduodenal artery (GDA) is frequently embolized in cases of upper GI bleed that has failed endoscopic therapy. Additionally, it may be done for GDA pseudoaneurysms or as an adjunctive procedure prior to Yttrim-90 (Y90) treatment of hepatic tumors. This clinical review will summarize anatomy and embryology of the GDA, indications, outcomes and complications of GDA embolization.
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Affiliation(s)
- Gokhan Kuyumcu
- Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale University School of Medicine, New Haven, CT 06519, USA.
| | - Igor Latich
- Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale University School of Medicine, New Haven, CT 06519, USA.
| | - Rulon L Hardman
- Division of Interventional Radiology, University of Utah Department of Radiology, Salt Lake City, UT 84108, USA.
| | - Gabriel C Fine
- Division of Interventional Radiology, University of Utah Department of Radiology, Salt Lake City, UT 84108, USA.
| | - Rahmi Oklu
- Department of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA.
| | - Keith B Quencer
- Division of Interventional Radiology, University of Utah Department of Radiology, Salt Lake City, UT 84108, USA.
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24
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Abstract
Empirical embolization of the gastroduodenal artery (GDA) is accepted as a safe and effective treatment option for endoscopy-refractory nonvariceal upper gastrointestinal bleeding (UGIB) in patients with high surgical risk. Nontarget embolization is a recognized complication of transarterial embolization, however, symptomatic pancreatic injury is extremely rare. We report a patient who developed acute ischemic pancreatitis immediately after embolization of the GDA, which was confirmed intraoperatively. Interventionists as well as referring clinicians need to be aware of this rare but life threatening complication.
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Affiliation(s)
- Wei Ming Chua
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
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25
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Belyaev O, Polle C, Herzog T, Munding J, Chromik AM, Meurer K, Tannapfel A, Bergmann U, Müller CA, Uhl W. Effects of intra-arterial octreotide on pancreatic texture: a randomized controlled trial. Scand J Surg 2015; 102:164-70. [PMID: 23963030 DOI: 10.1177/1457496913490457] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Octreotide is suggested to harden the pancreas, thus facilitating the construction of a pancreatic anastomosis and lowering the risk of postoperative fistula. We tested the hypothesis that intra-arterial application of octreotide in the gastroduodenal artery during pancreatectomy may increase pancreatic hardness. MATERIAL AND METHODS A single-center, prospective, double-blinded, randomized controlled trial with parallel assignment was conducted. Patients planned for a pancreatoduodenectomy or a total pancreatectomy, who had a palpatory and durometer proven (<40 Shore units) soft pancreas, were assigned to receive intraoperatively either 5 mL 500µg octreotide or 5 mL 0.9% saline solution as a bolus injection in the gastroduodenal artery. Pancreatic hardness was measured before, early, and late after intervention. The investigator performing the durometer measurements and pathologist were masked to group assignment. The primary outcome was increased pancreatic hardness. Analysis was by intention to treat. This trial is registered at http://www.clinicaltrials.gov (ID NCT01400100). RESULTS A total of 12 patients received octreotide and 13 received saline solution. Pancreatic hardness marginally increased in the octreotide group: 0.67 ± 2.3 Shore units, whereas it decreased in the control group: -2.15 ± 2.7 Shore units. The difference was statistically significant, p = 0.029 (95% confidence interval = -4.87 to -0.77). Histology did not find any correlate for this clinically irrelevant hardening effect. CONCLUSIONS A single bolus application of octreotide did not deliver a clinically relevant increase in pancreatic hardness. Future studies on the hardening effect of octreotide should employ repeated or continuous preoperative administration of this drug.
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Affiliation(s)
- O Belyaev
- Department of Surgery, St. Josef Hospital, Ruhr University of Bochum, Bochum, Germany
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26
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Abstract
Peripheral arterial aneurysms are uncommon; for some aneurysm types, data are limited to case reports and small case series. There is no Level A evidence in most cases to determine the choice between open or endovascular intervention. The evolution of endovascular technology has vastly improved the armamentarium available to the vascular surgeon and interventionalists in the management of these rare and unusual aneurysms. The choice of operative approach will ultimately be determined on an individual basis, dependent on the patient risk factors, and aneurysm anatomy. After consideration, some aneurysms (femoral, subclavian, carotid and ECAA) fare better with an open first approach; renal, splenic and some visceral artery aneurysms do better with an endovascular first approach. In our practice PAAs are treated with an endovascular first approach. For these rare conditions, both open and endovascular therapy will continue to work in harmony to enhance and extend the capabilities of modern surgical management.
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Affiliation(s)
- Irwin V Mohan
- Westmead Hospital, University of Sydney Medical School, Sydney, NSW 2145, Australia.
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