Hemorrhagic shock due to ruptured left and right gastric artery aneurysm

Abstract

Case: We report a case of hemorrhagic shock due to a ruptured gastric artery aneurysm successfully treated with transarterial embolization. A 72-year-old woman with cholangitis presented with hemoperitoneum following a ruptured aneurysm of the gastric artery.Outcome: Emergent computed tomography and angiography were carried out and the patient was found to have spontaneous bleeding from both branches of the left and right gastric arteries. Transcatheter embolization was carried out at the distal branch of both gastric arteries with a coil. The patient recovered well with no recurrent bleeding. Conclusions:Although rare, visceral artery rupture should be considered in the differential diagnosis of unexplained hemorrhagic shock with abrupt onset of hemoperitoneum. Computed tomography and angiography are useful tools for obtaining prompt and accurate localization of the bleeding points.

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

“…[ 3 ] Though there were several case reports of hemoperitoneum from rupture of gastroepiploic arteries, very few cases of hemorrhagic shock due to the rupture of left gastric artery aneurysm have been published in English medical works (recent being Nishimura et al and Nissim et al). [ 4 , 5 ] The patients can insidiously become unstable due to spontaneous rupture resulting in intraperitoneal hemorrhage, so they are frequently occult and often fatal. Because of the high mortality rate, early diagnosis and management are very important by prompt radiological examinations while correlating with laboratory investigations.…”

Post-traumatic pseudoaneurysms of the left gastric artery: A case report

“…Few cases with pseudoaneurysms and rupture of the gastric artery due to trauma have been reported [ [3] , [4] , [5] ], and no reports are available on delayed presentation of a left gastric artery pseudoaneurysm due to blunt trauma ( Table 1 ). The etiology of visceral artery pseudoaneurysms is not fully understood yet, but the causes might be atherosclerosis, inflammatory or degenerative vasculopathies, and trauma [ [2] , [3] , [4] , [5] ]. In this case, we believe the gastric artery pseudoaneurysm was caused by the patient's fall, since there was no evidence of any vascular abnormality or vasculitis on CT scan 3 months prior.…”

“…Prompt diagnosis and management are necessary because mortality is nearly 70–80% due to massive intra-abdominal hemorrhage [ 2 , 6 , 7 ]. There is no consensus as to the best treatment option, due to the paucity of case reports [ 2 ], but the primary goal of treatment for these cases of intra-abdominal bleeding is to control the hemorrhage by ligating or repairing the involved vessels [ 5 ]. Treatment can be done by either surgery or endovascular treatments [ 2 ].…”

A rare case of haemorrhagic shock secondary to spontaneous rupture of a branch of the left colic artery and the right gastric artery

“…Interventional radiology is increasingly playing an important role in the management of vascular bleeds. Successful arterial embolisation of the left and right gastric arteries was performed in a recent case reported by Nishimura et al 5 However, interventional radiology is limited to centres where the expertise exists. Thus, management of vascular bleeds via laparotomy is still performed in the vast majority of cases.…”