Significance of radiology in the diagnosis and management of ruptured left gastric artery aneurysm associated with acute pancreatitis

Abstract

Rationale:Left gastric artery aneurysms are very rare which progresses into hemorrhagic shock and diagnosis is very challenging particularly in patients with acute pancreatitis and cholecystitis whose vitals become unstable suddenly.Patient concerns:A 72-year-old female has presented with severe progressing abdominal pain was treated with total parenteral nutrition for acute pancreatitis based on preliminary work up, but suddenly became unstable with dropping vitals over the ensuing 48 hours. Physical examination has a positive Murphy sign and appeared lethargic. She has no past history of any chronic systemic illness or malignancy.Diagnoses:Ruptured left gastric artery aneurysm and left hepatic artery aneurysm with intraperitoneal hemorrhage associated with acute pancreatitis and cholecystitis.Interventions:Emergency interventional surgery was performed to embolize both the aneurysms and the giant aneurysmal sac of the left gastric artery was secured with a micrometallic occluding coil which eventually controlled the active hemorrhage.Outcomes:The patient became stable and was discharged after 15 days without any recurrence or complications during the 6-month follow-up.LessonsThis case is a peculiar example of a missed diagnosis of left gastric artery aneurysm associated with acute pancreatitis and cholecystitis with deteriorating clinical condition. Exhaustive radiological investigations are necessary for early diagnosis correlating with presenting clinical situations. Radiologists should be familiar with the challenges in diagnosis and management.

Left Gastric Artery Pseudoaneurysm Due to Pancreatitis

“…One of these branches turns sharply downward and travels along the lesser curvature to anastomose with the right gastric artery branches. They can arise in the portion of the artery lying outside the gastric wall (extramural) or within the gastric wall (intramural); both types, if ruptured, may result in severe life-threatening complications due to intra-gastric or intraperitoneal spontaneous massive hemorrhage [7]. Pseudoaneurysm of the splenic artery is more common than LGA.…”

Giant Celiac Artery Pseudoaneurysm in a Case of Chronic Pancreatitis: A Rare Case Report With Literature Review

“…CECT / CT angiography is a fundamental diagnostic tool that provides us details with high accuracy regarding the site, size, and extent of pseudoaneurysm and the involved artery and its adjacent effect on viscera. 10 The typical appearance in CECT is a well-defined mass with hyperdensity in the center due to contrast enhancement and relatively less density in the periphery due to the fibrous wall. 11 3D reconstruction can be done using volume rendering multiplanar techniques and helps pre-procedural planning and individualize the anatomy of arterial structures.…”

Left Gastric Pseudoaneurysm in a Case of Chronic Pancreatitis: A Case Report With Review of Literature

“…Gastric artery pseudoaneurysms are relatively less common with very few cases in literature. Recent case reports of left gastric artery pseudoaneurysms with review of literature 1,2 have referred to about 14 and 17 cases reported till now. There are few more isolated case reports 3-10 including 2 patients of left gastric pseudoaneurysms due to blunt trauma of abdomen.…”

“…CT angiogram is the most sensitive noninvasive imaging modality for detection of pseudoaneurysms. 2 CT also serves as a road map for endovascular embolization, providing information about the vessel anomalies and tortuosity. Digital Subtraction angiography (DSA) is usually done prior to embolization as part of the intervention.…”