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Kohama K, Ito Y, Kai T, et al. Successfully treated life-threatening upper gastrointestinal bleeding from fistula between gastroduodenal artery pseudoaneurysm and duodenum. Acute Med Surg. 2015;3(2):192-194doi: 10.1002/ams2.157.
Kohama, K., Ito, Y., Kai, T., Kotani, J., & Nakao, A. (2016). Successfully treated life-threatening upper gastrointestinal bleeding from fistula between gastroduodenal artery pseudoaneurysm and duodenum. Acute medicine & surgery, 3(2), 192-194. https://doi.org/10.1002/ams2.157
Kohama, Keisuke, et al. "Successfully treated life-threatening upper gastrointestinal bleeding from fistula between gastroduodenal artery pseudoaneurysm and duodenum." Acute medicine & surgery vol. 3,2 (2016): 192-194. doi: https://doi.org/10.1002/ams2.157
Kohama K, Ito Y, Kai T, Kotani J, Nakao A. Successfully treated life-threatening upper gastrointestinal bleeding from fistula between gastroduodenal artery pseudoaneurysm and duodenum. Acute Med Surg. 2015 Sep 22;3(2):192-194. doi: 10.1002/ams2.157. eCollection 2016 Apr. PMID: 29123781; PMCID: PMC5667383.
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Acute Med Surg. 2015 Sep 22;3(2):192-194. doi: 10.1002/ams2.157. eCollection 2016 Apr.

Successfully treated life-threatening upper gastrointestinal bleeding from fistula between gastroduodenal artery pseudoaneurysm and duodenum.

Acute medicine & surgery

Keisuke Kohama, Yusuke Ito, Tatsuro Kai, Joji Kotani, Atsunori Nakao

Affiliations

  1. Senri Critical Care Medical Center Saiseikai Senri Hospital Suita Osaka Japan.
  2. Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Nishinomiya Japan.

PMID: 29123781 PMCID: PMC5667383 DOI: 10.1002/ams2.157

Abstract

CASE: An 85-year-old man was admitted to the hospital, underwent laparotomy, and was diagnosed with diffuse peritonitis due to perforation of gastric ulcer. Omental patch repair was carried out. After surgery, he suddenly vomited blood and manifested hypovolemic shock. An emergency upper gastrointestinal endoscopy was carried out immediately. However, the bleeding source was not visible. Dynamic-enhanced abdominal computed tomography showed a pseudoaneurysm of the gastroduodenal artery-communicating duodenal lumen with extravasation. Next, the patient underwent angiography for embolization. However, selective arterial embolization was not successful.

OUTCOME: Finally, duodenotomy was carried out. The fistula between the pseudoaneurysm and duodenal lumen was directly ligated. An aneurysm could be clearly identified by previous findings.

CONCLUSIONS: Gastroduodenal artery aneurysms are very uncommon but possibly lethal if they rupture. This life-threatening condition requires rapid diagnosis and treatment. Minimally invasive treatment is the preferred therapy for gastroduodenal artery aneurysm; however, acute care surgery should be considered without hesitation when conditions are critical.

Keywords: Aneurysm; disease management; endoscopy; gastrointestinal; minimally invasive surgical procedures

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