Gastroepiploic artery pseudoaneurysm: a rare cause of abdominal pain

Multiple Aneurysms or Pseudoaneurysms of the Gastroepiploic Artery: An Anecdotal Cause of Hemoperitoneum

“…Given the rarity of GEAA [3], the estimation of true Gastroepiploic Artery Pseudoaneurysms (GEAP) has been performed retrospectively and, in a few cases, found that 50% of GEAA are actually GEAP [2]. Abdominal trauma with intimal injury and weakening of the vascular wall has been proposed as the main etiological factor of these pseudoaneurysms [5]. Other causes such as the enzymatic proteolytic effect in chronic pancreatitis, chronic cholecystitis, infectious causes (abscesses), iatrogenic surgical trauma or percutaneous biliary intervention, systemic vasculitis, segmental arterial mediolysis, and malignancy have been reported [4][5][6][7].…”

“…Magnetic resonance angiography is another option; however, it is limited by the decrease in contrast resolution, long acquisition times, lower availability, and higher costs. It may be an option in stable patients who tolerate the procedure and seek radiation limitation [4,5].…”

“…Angiography remains the Gold Standard; however, in the current scenario, it is only indicated when embolizing a pseudoaneurysm identified by the previous imaging methods is sought or when there is high clinical suspicion, but the non-invasive radiological studies are normal. An advantage of angiography is the ability to assess hemodynamics in real-time, which helps determine management [4,5].…”

“…In this regard, successful endovascular management of more than 90% makes it the main management option with embolization using coils, stents, plugs, liquid embolic agents, or thrombin injection [2][3][4][5][6]8,9,13]. Perforation of the lateral branch of the gastroduodenal artery during the interventional procedure has been reported [10].…”

“…Perforation of the lateral branch of the gastroduodenal artery during the interventional procedure has been reported [10]. When the endovascular pathway is complex due to vascular tortuosity with acute angles, percutaneous embolization with tomography or ultrasound guidance is another option [2,5,14]. Surgical management with laparotomies and hemorrhage control may be necessary, especially in cases where the distal circulation needs to be preserved or is at risk [1,13,15].…”