Delayed Hemorrhage from Gastroduodenal Artery Pseudoaneurysm following Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Head Mass

Abstract

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a well-established procedure for the diagnosis of pancreatobiliary disease. Serious complications such as perforation, pancreatitis, hemorrhage, and sepsis are rarely reported. To our knowledge, delayed hemorrhage after EUS-FNA is very rare and hemorrhage from iatrogenic pseudoaneurysm has yet to be reported. We report a case of delayed hemorrhage from gastroduodenal artery pseudoaneurysm, which developed after EUS-FNA of a solid pancreatic lesion. A 68-year-old man presented with tarry stool 10 days after EUS-FNA of a 1.5 cm-sized pancreatic head mass. Abdominal computed tomography showed a 2-cm-sized intensely enhancing round lesion near pancreatic head. EUS-FNA was negative for malignancy. The patient refused admission for further evaluation. Twelve days later, he reported to the emergency room with persistent tarry stool. Angiography showed a gastroduodenal artery pseudoaneurysm. Subsequent coil embolization resulted in successful hemostasis. The patient underwent pylorus-preserving pancreaticoduodenectomy and was diagnosed with stage IIB pancreatic cancer.

Transcatheter Arterial Embolization for Bleeding Caused by Endoscopic Ultrasound-Guided Fine-Needle Aspiration: A Case Series

“…TAE was performed for an inferior pancreaticoduodenal artery pseudoaneurysm; however, the patient died a few days later. Another study reported a case of bleeding complications ten days after EUS-FNA for a pancreatic head mass [ 6 ]. TAE was performed for a gastroduodenal artery branch pseudoaneurysm, and the bleeding was successfully controlled.…”

“…Bleeding is self-limiting in most cases, and endoscopic hemostasis and blood transfusions are rarely needed [ 4 ]. However, in a few cases of massive bleeding caused by EUS-FNA, transcatheter arterial embolization (TAE) has been reportedly used [ 5 , 6 ]. Here, we present a case series of six patients who underwent TAE for bleeding due to EUS-FNA.…”