Gastroduodenal Artery Pseudoaneurysm Associated with Hemosuccus Pancreaticus and Obstructive Jaundice

Bohl, Jaime L.; Dossett, Lesly A.; Grau, Ana M.

doi:10.1007/s11605-007-0231-y

Cited by 25 publications

(27 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Color and pulse Doppler sonography further enhance test sensitivity and specificity by demonstrating turbulent blood flow (“to and fro” sign) within the PA. Angiography is the gold standard diagnostic test: it identifies the affected artery, determines local vascular anatomy, and permits interventional therapy. [55] This case represents the first case of LGA PA diagnosed by MRCP. Abdominal CT with intravenous contrast showed a pancreatic/peripancreatic mass, initially suspicious for pancreatic adenocarcinoma, but MRCP demonstrated that the mass was vascular, and likely originated from the LGA.…”

Section: Discussionmentioning

confidence: 93%

“…However, endoscopic ultrasound (EUS) is superior to CT for diagnosing small PAs. [43,54,55] PAs usually appear on transabdominal ultrasonography as anechoic, frequently pulsatile lesions, and often contain a cyst within a larger anechoic mass. Color and pulse Doppler sonography further enhance test sensitivity and specificity by demonstrating turbulent blood flow (“to and fro” sign) within the PA. Angiography is the gold standard diagnostic test: it identifies the affected artery, determines local vascular anatomy, and permits interventional therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Angioembolization provides definitive therapy in about 78% of all bleeding visceral PAs, and provides partially successful therapy to stabilize a patient before definitive surgical therapy in many of the remaining cases. [55] Rebleeding is the most common complication of angioembolization. [53] Alternative therapies include endovascular stents or vascular surgery which is reserved for patients who are appropriate surgical candidates, and who have either failed angioembolization or have other surgical indications, such as pancreatic pseudocyst, pancreatic abscess, or gastric outlet obstruction.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Case report and systematic literature review of a novel etiology of sinistral portal hypertension presenting with UGI bleeding

et al. 2017

View full text Add to dashboard Cite

Introduction:A novel case is reported of upper gastrointestinal (UGI) bleeding from sinistral portal hypertension, caused by a left gastric artery (LGA) pseudoaneurysm (PA) compressing the splenic vein (SV) that was successfully treated with PA embolization.Case report:A 41-year-old man with previous medical history of recurrent, alcoholic pancreatitis presented with several episodes of hematemesis and abdominal pain for 48 hours. Physical examination revealed a soft abdomen, with no abdominal bruit, no pulsatile abdominal mass, and no stigmata of chronic liver disease. The hemoglobin declined acutely from 12.3 to 9.3 g/dL. Biochemical parameters of liver function and routine coagulation profile were entirely within normal limits. Abdominal CT revealed a 5-cm-wide peripancreatic mass compressing the stomach and constricting the SV. Esophagogastroduodenoscopy showed blood oozing from portal hypertensive gastropathy, small nonbleeding gastric cardial and fundal varices, gastric compression from the extrinsic mass, and no esophageal varices. MRCP and angiography showed that the mass was vascular, arose from the LGA, compressed the mid SV without SV thrombosis, and caused sinistral portal hypertension. At angiography, the PA was angioembolized and occluded. The patient has been asymptomatic with no further bleeding and a stable hemoglobin level during 8 weeks of follow-up.Discussion:Literature review of the 14 reported cases of LGA PA revealed that this report of acute UGI bleeding from sinistral portal hypertension from a LGA PA constricting the SV is novel; one previously reported patient had severe anemia without acute UGI bleeding associated with sinistral portal hypertension from a LGA PA.Conclusion:A patient presented with UGI bleeding from sinistral portal hypertension from a LGA PA compressing the SV that was treated by angiographic obliteration of the PA which relieved the SV compression and arrested the UGI bleeding. Primary therapy for this syndrome should be addressed to obliterate the PA and not the secondarily constricted SV.

show abstract

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Case report and systematic literature review of a novel etiology of sinistral portal hypertension presenting with UGI bleeding

et al. 2017

View full text Add to dashboard Cite

show abstract

“…The interesting part of this case is not only the bleeding gastroduodenal pseudoaneurysm, which it is by itself a rarity, but also the presentation with epigastric pain, hyperamylasaemia and obstructive jaundice. Whereas there are several cases of GDA bleeding aneurysm presenting with obstructive jaundice7 21 22 or gastrointestinal haemorrhage from either direct intraluminal bleeding of the aneurysm in the duodenum2 or indirectly intraductal bleeding inside the common bile duct8 or pancreatic duct, a condition called haemosuccus pancreaticus9 10 or both,23 there is very limited bibliography of GDA cases presenting with hyperamylasaemia 24. The biochemical results can be explained by two mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Pseudoaneurysm of the gastroduodenal artery: an unusual cause for hyperamylasaemia

Galanakis¹

2018

BMJ Case Reports

View full text Add to dashboard Cite

A 79-year-old man was admitted electively for investigation of weight loss. While he was an inpatient, he developed severe epigastric pain and an initial blood test revealed an acutely raised amylase (>2000) and deranged liver function tests. A contrast CT angiography showed a large haematoma adjacent to the duodenum, spreading in the retroperitoneal space, arising from a 2 cm bleeding pseudoaneurysm in the region of the gastroduodenal artery. Due to his underlying comorbidities, he was deemed unfit for surgical repair and he had coil embolisation with successful haemostasis. The gastroduodenal artery aneurysms are rare and constitute 1.5% of all visceral artery aneurysms. They can be an incidental finding or they can present with haemorrhagic shock, abdominal pain and rarely with obstructive jaundice or hyperamylasaemia. The diagnosis is usually made with an angiography. Variable treatment options are available depending on the patient's fitness and haemodynamic stability.

show abstract

“…Arteriography is the most valuable diagnostic test to detect Splanchnic artery aneurysms and the exact location of bleeding [11, 12]. However, this technique requires a trained interventional radiologist.…”

Section: Discussionmentioning

confidence: 99%

Ascending Cholangitis secondary to migrated embolization coil of gastroduodenal artery pseudo-aneurysm a case report

et al. 2017

View full text Add to dashboard Cite

BackgroundGastroduodenalartery (GDA) pseudo-aneurysms are very rare. Their clinical importance lies in the eventuality of rupture, causing bleeding and ultimately exsanguination.Case presentationWe report the case of a man, with prior history of biliary surgery, presenting with haemobilia secondary to a rupture of GDA pseudo-aneurysm eroding the main bile duct. The patient was treated with coil embolization. This technique is considered to be safe. However, on the long term, some complications may occur. In our case, the patient presented with cholangitis subsequent to coil migration in the lower bile duct. This situation was managed using endoscopic retrograde cholangiopancreatography (ERCP) allowing coil extraction with favorable evolution.ConclusionsGDA pseudo-aneurysms are very rare. Bleeding, secondary to the rupture of these lesions, is a serious complication that could lead to death. Diagnosis and treatment of ruptured GDA pseudo-aneurysms rely on angiography. This method is considered to be safe. Cholangitis secondary to coil migration in the main bile duct is exceedingly rare,but remains an eventuality that physicians should be cognizant of.

show abstract

Gastroduodenal Artery Pseudoaneurysm Associated with Hemosuccus Pancreaticus and Obstructive Jaundice

Cited by 25 publications

References 5 publications

Case report and systematic literature review of a novel etiology of sinistral portal hypertension presenting with UGI bleeding

Case report and systematic literature review of a novel etiology of sinistral portal hypertension presenting with UGI bleeding

Pseudoaneurysm of the gastroduodenal artery: an unusual cause for hyperamylasaemia

Ascending Cholangitis secondary to migrated embolization coil of gastroduodenal artery pseudo-aneurysm a case report

Contact Info

Product

Resources

About