Pulsation of visible vessel or adherent clot in duodenal ulcer may indicate pseudoaneurysm: Case series

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.

Successful endoscopic combined with endovascular haemostasis of a ruptured pseudoaneurysm of the duodenal bulb: A case report

“…Since, the duodenal wall is thin and adjacent to the GDA, the erosive, duodenal ulcer has the potential to invade the GDA and cause a pseudoaneurysm. 8 Angiography has emerged as a gold standard for diagnosis and an effective treatment when a gastroduodenal pseudoaneurysm is suspected. 9 Contrast-enhanced CT is an excellent non-invasive modality to demonstrate the features of a pseudoaneurysm, but its sensitivity is lower than that of angiography (67% vs. 100%).…”

“…This is due in part to the narrowness of the duodenal bulb. 8,12 In addition, it is difficult to operate when the ulcer is bleeding and the vision is poor. Also, the task of controlling the bleeding by the GDA by hemoclipping or thermocoagulation can be difficult, even when using an over-the-scope clip.…”

“…Since, the duodenal wall is thin and adjacent to the GDA, the erosive, duodenal ulcer has the potential to invade the GDA and cause a pseudoaneurysm. 8…”

“…9 Contrast-enhanced CT is an excellent non-invasive modality to demonstrate the features of a pseudoaneurysm, but its sensitivity is lower than that of angiography (67% vs. 100%). 8 The multiphase acquisitions of multidetector computed tomography angiography (MDCTA) allows a detailed assessment of the vascular anatomy and, is considered by some investigators as the 'new' gold-standard, alongside angiography. 10,11 In our case, the patient was too weak to tolerate a contrast-enhanced CT, and so celiac artery angiography was used to identify the pseudoaneurysm and embolize it successfully.…”