Spontaneous haemorrhage from a left gastric artery aneurysm as a cause of acute abdominal pain

Abstract

Visceral artery aneurysms are rare, with a reported incidence of less than 2% in the general population.1,2 Aneurysms of the left gastric artery are particularly uncommon, accounting for 4% of all visceral aneurysms. 3,4 Although the majority are discovered incidentally and can be managed conservatively, prompt treatment of those ruptured or at risk of rupture is crucial to reduce the associated morbidity. Increasing awareness of visceral artery aneurysms as a cause of spontaneous intraperitoneal haemorrhage will improve early recognition and impact on survival. We present a rare case of spontaneous rupture of a left gastric artery aneurysm. KEYWORDSRuptured aneurysm -Haemoperitoneum -Visceral artery aneurysm -Gastric artery aneurysm Case historyA 60-year-old woman presented to our local hospital with acute onset chest and upper abdominal pain, with vomiting and hypotension. Examination demonstrated a soft but tender and distended abdomen, with a systolic blood pressure of 78mmHg and haemoglobin of 116g/l. She had a past medical history of hypertension treated with amlodipine, bendroflumethiazide and ramipril.Despite aggressive fluid resuscitation, she remained hypotensive. Her haemoglobin dropped to 67g/l and 2 units of red blood cells were transfused. This prompted urgent contrast-enhanced computed tomography (CT) of the chest and abdomen, which demonstrated an acute intraperitoneal bleed with a large haematoma in the lesser sac. A diagnosis of spontaneous haemorrhage from a left gastric artery aneurysm was made, owing to a demonstrable focus of active contrast extravasation close to the left gastric artery (Fig 1). The images were reviewed at the regional vascular centre and the patient was transferred for coil embolisation of the left gastric artery (Fig 2). Post intervention, the patient made a gradual but full recovery.Following successful embolisation, further investigations were performed to identify contributory factors for the aneurysm development and to assess for further aneurysms. Echocardiography showed mild mitral regurgitation. Magnetic resonance angiography of the brain demonstrated normal anatomy of the circle of Willis and no evidence of intracranial aneurysms. CT angiography confirmed two further visceral artery aneurysms both on the splenic artery, one measuring 6mm in diameter and the other 11mm. On review of the initial CT imaging, these splenic artery aneurysms could be seen but they were not reported at the time; they were visualised at angiography during embolisation. The patient has remained under long-term surveillance of these aneurysms, with regular imaging and outpatient follow-up. She has also been referred to a specialist rheumatology clinic to exclude underlying connective tissue disorders. DiscussionVisceral artery aneurysms (VAAs) affect branches of the abdominal aorta supplying the abdominal organs, with 80% found on the splenic and hepatic arteries. 1 They are rare and have a reported incidence of less than 2% in the general population, a figure that is rising with ...

Visceralinės Aneurizmos: Literatūros Apžvalga

“…arterijų, kitų arterijų -dar retesnės: pilvinio kamieno -4 proc., skrandžio -4 proc. [1,20,21], viršutinės pasaito -3,2 proc. [7,22], apatinės pasaito -pavieniai atvejai [9] (5 pav.…”

“…Esant šioms būklėms, ypač nėščioms moterims, taip pat esant spontaniniam hemiperitoneumui, svarbu pagalvoti apie plyšusios VA galimybę ir atlikti diferencinę diagnostiką [1,23,28].…”

Visceralinių Aneurizmų Gydymo Patirtis Vilniaus Miesto Klinikinėje Ligoninėje

“…populiacijos [1]. VA dažniausiai nustatomos atsitiktinai dėl kitų nesusijusių ligų atlikus vaizdinius pilvo organų tyrimus -pilvo echoskopiją, kompiuterinės tomografijos ar magnetinio rezonanso tyrimus [2].…”

“…Literatūroje taip pat nurodoma, kad dažniausios visceralinės aneurizmos yra blužnies, rečiau -kepenų, dar rečiau pažeidžia kitas arterijas [1,10,11,12,13,14,15].…”

“…Echoskopiškai nustačius skystį (tikriausiai kraują) pilve, buvo atlikta kompiuterinė tomografija, patvirtinusi netipiškai atsišakojančios a. hepatica sinistra aneurizmos diagnozę. Literatūroje nurodoma, kad reikia įtarti visceralines aneurizmas esant staiga atsiradusiam pilvo skausmui, hipotenzijai, nustačius hemoperitoneumą, ir atlikti diferencinę diagnostiką [1,22,23].…”