Right hepatic artery injury: an unusual complication of penetrated duodenal ulcer disease

Abstract

Peptic ulcers generally appear in the stomach and the first segment of the duodenum as a result of mucosal erosion caused by pepsin and gastric acid secretion, with up to 70% of these occurring amongst patients aged 25-64. Currently, endoscopic procedures combined with proton pump inhibitors are considered the gold standard for managing complicated peptic ulcers, leaving surgical management as an option for endoscopic management failure or in scenarios such as incoercible bleeding, perforation, penetration and intestinal occlusion. Penetration of a gastric ulcer to adjacent organs is a rare complication; penetration to the liver and endoscopic diagnosis is even rarer. We have presented the case of a 54 year old diabetic male, who presented to the emergency room with upper gastrointestinal bleeding due to a chronic duodenal ulcer, with haemodynamic instability, requiring surgical management, revealing penetration to the liver with rupture of the right hepatic artery. The patient successfully recovered after surgery and was discharged 7 days after surgical intervention. We did not find any similar case reports in the current literature

Hepatic arterial haemorrhage caused by duodenal ulcer

“…However, as the case in this report illustrates, other foregut vessels can become involved with erosive duodenal ulcers, with potential to precipitate profuse GI bleeding. Prior reports of non-GDA vessels implicated in GI bleeding from ulcer erosion include the cystic artery,3–5 the common hepatic artery6 7 and a rare anatomical variant in which the supraduodenal artery arises from the left hepatic artery 10 11…”

“…Most posterior wall duodenal bulb ulcers erode into the gastroduodenal artery (GDA), which is the first vessel that is angiographically interrogated in these cases 1 2. Very few cases have been previously reported involving bleeding from hepatic arterial branches 3–11. Here we report a case of GI bleeding caused by duodenal ulcer erosion into the proper hepatic artery, highlighting the potential for non-GDA vessels to drive serious and life-threatening GI bleeding and emphasising the clinical need for carefully interrogating vessels more distal in the coeliac axis in all patients with an upper GI bleed when the source of bleeding is not initially localised on angiography.…”

Reparación de ulcera gástrica prepilorica y duodenal reporte de caso

“…Entre las principales complicaciones se encuentran el sangrado, fuga de la reparación, inestabilidad hemodinámica, falla en la reparación debido a lesión de mayor tamaño, las cuales también son de las principales causas de conversión del procedimiento, en menor medida existe reporte de caso de lesión de arteria hepática como complicación agregada. (11)(12)(13)(14) El objetivo principal de este artículo es el dar a conocer el manejo quirúrgico, la evolución y el seguimiento de una perforación gástrica Johnson II en el cual se realiza una reparación abierta anastomosando estómago y yeyuno posterior a la reparación de la ulcera duodenal con cierre primario.…”