Small Bowel Obstruction: A Rare Presentation of the Inferior Pancreaticoduodenal Artery Pseudoaneurysm Bleed

Abstract

Intra-abdominal and intramural hematomas are well-known complications of pseudoaneurysms. We present a case of small bowel obstruction as a result of external mechanical compression from hematoma. Bleeding was localized to the pseudoaneurysm of the gastroduodenal artery and inferior pancreaticoduodenal artery. Angiography was used to control the bleeding with coil embolization. This rare clinical manifestation represents just one of the symptoms associated with pseudoaneurysms of the gastrointestinal tract. Therapeutic options are discussed along with a review of the literature.

An Unusual Cause of Gastric Outlet Obstruction

“…and hepatic artery (16.2%). 1,2 Common presentations of visceral pseudoaneurysms include hypotension owing to acute hemorrhage or incidental findings due to the increased use of CT scans. The most dangerous complication of pseudoaneurysm is rupture leading to hemorrhage, which has a mortality rate of 17%, and happens when the pseudoaneurysm enlarges owing to intracystic pressure.…”

“…1 There have been previous reports of intramural hematoma of the duodenum causing bowel obstruction, which usually involves other preceding pathology, such as pancreatitis, pancreatic carcinoma, blood dyscrasia, mesenteric cyst, or ruptured aneurysms. 2 Another common cause of is trauma, which affects hollow viscera or solid organs near their point of fixation. 2,3 Common sites of intestinal injury are the duodenum, upper jejunum, and terminal ileum owing to their relatively immobility; trauma usually inflicts a shearing action on the viscus against the spinal column.…”

“…2 Another common cause of is trauma, which affects hollow viscera or solid organs near their point of fixation. 2,3 Common sites of intestinal injury are the duodenum, upper jejunum, and terminal ileum owing to their relatively immobility; trauma usually inflicts a shearing action on the viscus against the spinal column. 2,3 However, in this case, there was no preceding pathology for the patient's pseudoaneurysm and the patient's presentation mimicked that of malignancy.…”

“…2,3 Common sites of intestinal injury are the duodenum, upper jejunum, and terminal ileum owing to their relatively immobility; trauma usually inflicts a shearing action on the viscus against the spinal column. 2,3 However, in this case, there was no preceding pathology for the patient's pseudoaneurysm and the patient's presentation mimicked that of malignancy. To our knowledge, GOO secondary to a hematoma formation from a recent hemorrhage of a visceral pseudoaneurysm, with no preceding pathology has rarely been reported.…”