Gastroduodenal Artery Pseudoaneurysm Rupture Post-Billroth II Surgery: Case Report

Abstract

Visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPAs) are defined as more than a 1.5 fold increase in the normal diameter of the celiac, superior, or inferior mesenteric arteries and their branches. They represent a rare finding with an incidence ranging between 0.1% to 0.2%. Depending on the mechanism of formation, aneurysms can be divided into true aneurysms or pseudoaneurysms. True aneurysms involve all layers of the wall, which are usually thinned but remain intact and commonly result from vessel wall abnormalities. However, pseudoaneurysms occur after vascular injuries or nearby inflammatory process causing a tear in the vessel wall. Pancreatitis is the most common cause of pseudoaneurysm. Nevertheless, other conditions, such as autoimmune disorders, vascular interventions, laparoscopic cholecystectomy, and even hepatic transplantation, have been reported to increase the risk of pseudoaneurysm formation. Herein, we are reporting a case of a gastroduodenal artery pseudoaneurysm rupture in a patient with altered anatomy secondary to Billroth II surgery.

Ruptured Gastroduodenal Artery Pseudoaneurysms as a Complication of Pancreatitis

“…Pseudoaneurysm can result from trauma, inflammation (e.g., pancreatitis), infection, and iatrogenic causes (e.g., vascular interventions, intra-abdominal surgeries). Due to its weak structural support, the risk of rupture is higher for pseudoaneurysm than that of a true aneurysm of similar size [7][8][9]. Our patient developed visceral arterial pseudoaneurysms secondary to inflammation from his severe acute pancreatitis likely due to gallstones given the sonographic findings and was unlikely related to his alcohol, human immunodeficiency virus, or antiretroviral medication use.…”

Hematemese Reveling the Rupture of a False Aneurysm of The Gastroduodenal Artery: A Rare Complication of Gastrectomy

“…The aneurysm of the gastroduodenal artery, like all those of the splanchnic system, has several etiologies such as infection, trauma, pancreatitis and surgical intervention with vascular injury [5][6][7][8]. In our case, we talk about an iatrogenic cause, namely a trauma of the gastroduodenal artery during lymph node dissection.…”

“…Pseudoaneurysm of visceral arteries, particularly the gastroduodenal artery, may be asymptomatic or may lead to abdominal pain, abdominal compartment syndrome (nausea, vomiting) or pulsatile abdominal mass [8].…”

“…Therefore, an abdominal Coronary CT angiography (CTA) was performed, allowing to reach the diagnosis. Thus, the definitive diagnosis is established by the imaging represented by CT angiography (CTA) [4,5,8,11]. Its sensitivity is estimated at 100%.…”

Outpatient Management of Gastroduodenal Artery Aneurysm

“…In the outpatient setting, it is important to recognize the most common symptoms associated with this condition; gastrointestinal bleeding, hematemesis, and abdominal pain [ 1 ]. Only 7.5% of GDA aneurysms are symptomatic [ 3 ] and may be found incidentally on imaging for other reasons. Regardless, all GDA aneurysms should be treated once diagnosed.…”