Unusual case of upper gastrointestinal haemorrhage secondary to a ruptured gastroduodenal artery pseudoaneurysm: case presentation and literature review

2020 ◽  
Vol 13 (11) ◽  
pp. e236463
Author(s):  
Gasim Ahmed ◽  
Mehsim Abid ◽  
Sharath Hosmane ◽  
Smitha Mathew
Keyword(s):  
Epigastric Pain ◽  
Gastrointestinal Haemorrhage ◽  
Gastroduodenal Artery ◽  
Laboratory Evaluation ◽  
Blood Collection ◽  
Upper Gastrointestinal Endoscopy ◽  
Amylase Level ◽  
Dark Blood ◽  
Artery Pseudoaneurysm ◽  
Upper Gastrointestinal

Pseudoaneurysm rupture of the gastroduodenal artery (GDA) is life-threatening and can present as an acute upper gastrointestinal haemorrhage. Here, we present a case of upper gastrointestinal haemorrhage arising from a ruptured GDA pseudoaneurysm. A 56-year-old woman presented acutely with haematemesis. She reported ongoing upper epigastric pain for a few weeks. Laboratory evaluation revealed severe microcytic hypochromic anaemia (haemoglobin, 69 g/L; normal, 120–140 g/L) and a mildly raised serum amylase level. Upper gastrointestinal endoscopy revealed dark blood collection between the rugae of the distal stomach. An abdominal CT scan detected a homogeneously enhancing rounded lesion arising from the GDA adjacent to the second part of the duodenum. The median arcuate ligament was causing stenosis of the coeliac axis origin. The diagnosis of haematemesis secondary to a ruptured GDA pseudoaneurysm was confirmed by mesenteric angiography, and aneurysmal embolisation was done. The haemoglobin level stabilised after aneurysmal embolisation.

scholarly journals Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Kurniawan Kurniawan ◽  
I Dewa Nyoman Wibawa ◽  
Gde Somayana ◽  
I Ketut Mariadi ◽  
I Made Mulyawan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gastrointestinal Bleeding ◽  
Abdominal Trauma ◽  
Upper Gastrointestinal Bleeding ◽  
Rare Complication ◽  
Gastroduodenal Artery ◽  
Time Interval ◽  
Artery Pseudoaneurysm ◽  
History Of ◽  
Upper Gastrointestinal

Abstract Background Hemobilia is a rare cause of upper gastrointestinal bleeding that originates from the biliary tract. It is infrequently considered in diagnosis, especially in the absence of abdominal trauma or history of hepatopancreatobiliary procedure, such as cholecystectomy, which can cause arterial pseudoaneurysm. Prompt diagnosis is crucial because its management strategy is distinct from other types of upper gastrointestinal bleeding. Here, we present a case of massive hemobilia caused by the rupture of a gastroduodenal artery pseudoaneurysm in a patient with a history of laparoscopic cholecystectomy 3 years prior to presentation. Case presentation A 44-year-old Indonesian female presented to the emergency department with complaint of hematemesis and melena accompanied by abdominal pain and icterus. History of an abdominal trauma was denied. However, she reported having undergone a laparoscopic cholecystectomy 3 years prior to presentation. On physical examination, we found anemic conjunctiva and icteric sclera. Nonvariceal bleeding was suspected, but esophagogastroduodenoscopy showed a blood clot at the ampulla of Vater. Angiography showed contrast extravasation from a gastroduodenal artery pseudoaneurysm. The patient underwent pseudoaneurysm ligation and excision surgery to stop the bleeding. After surgery, the patient’s vital signs were stable, and there was no sign of rebleeding. Conclusion Gastroduodenal artery pseudoaneurysm is a rare complication of laparoscopic cholecystectomy. The prolonged time interval, as compared with other postcholecystectomy hemobilia cases, resulted in hemobilia not being considered as an etiology of the gastrointestinal bleeding at presentation. Hemobilia should be considered as a possible etiology of gastrointestinal bleeding in patients with history of cholecystectomy, regardless of the time interval between the invasive procedure and onset of bleeding.

scholarly journals CandidaEsophagitis in an Immunocompetent Pregnant Woman

1993 ◽  
Vol 1 (3) ◽  
pp. 149-152 ◽  
Author(s):  
Jeffrey S. Greenspoon ◽  
Seth Kivnick
Keyword(s):  
Human Immunodeficiency Virus ◽  
Weight Loss ◽  
Candida Albicans ◽  
Gastrointestinal Endoscopy ◽  
Epigastric Pain ◽  
Upper Gastrointestinal Endoscopy ◽  
Second Trimester ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Upper Gastrointestinal

Background:Nausea and vomiting are common during the first half of pregnancy and usually require only supportive measures. When symptoms are progressive and weight loss occurs, treatable causes should be sought by means of upper gastrointestinal endoscopy. We report a case of an immunocompetent gravida with invasiveCandida albicansesophagitis.Case:The immunocompetent primigravida developed progressive nausea, vomiting, epigastric pain, and a 4.1 kg weight loss during the second trimester of pregnancy. Treatment with metoclopramide and cimetidine for presumed gastroesophageal reflux was not effective. The patient had normal T-cell CD4 and CD8 subsets and was human immunodeficiency virus (HIV) antibody negative. Upper gastrointestinal endoscopy revealedC. albicansesophagitis which was treated with oral nystatin. The esophagitis had resolved completely when reassessed postpartum. The use of histamine2blockers is associated with an increased risk for fungal esophagitis and may have been a contributing cause in this case.Conclusion:Pregnant patients with persistent nausea, vomiting, and weight loss should be evaluated by endoscopy for fungal esophagitis.

The Diagnosis and Prognosis of Upper Gastrointestinal Haemorrhage

1980 ◽  
Vol 66 (1) ◽  
pp. 11-14
Author(s):  
R.H. Hunt
Keyword(s):  
Gastrointestinal Bleeding ◽  
Gastrointestinal Endoscopy ◽  
Upper Gastrointestinal Bleeding ◽  
Gastrointestinal Haemorrhage ◽  
Accurate Diagnosis ◽  
Upper Gastrointestinal Endoscopy ◽  
The Past ◽  
Diagnosis And Prognosis ◽  
Upper Gastrointestinal ◽  
Overall Mortality

AbstractThere have been major advances in the diagnosis and management of upper gastrointestinal bleeding over the past two decades but the overall mortality figure remains about 10 per cent. This paper reviews the place of upper gastrointestinal endoscopy in diagnosis and discusses the argument that this form of earlier, more accurate diagnosis has had no influence on the outcome of the condition.

scholarly journals Acute Gastric Volvulus on Hiatal Hernia

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Abdessamad EL KAOUKABI ◽  
Mohamed MENFAA ◽  
Samir HASBI ◽  
Fouad SAKIT ◽  
Abdelkrim CHOHO
Keyword(s):  
Hiatal Hernia ◽  
Gastrointestinal Endoscopy ◽  
Epigastric Pain ◽  
Gastric Volvulus ◽  
Upper Gastrointestinal Endoscopy ◽  
Rare Entity ◽  
Midline Laparotomy ◽  
Acute Gastric Volvulus ◽  
Upper Abdominal ◽  
Upper Gastrointestinal

The gastric volvulus is defined as an abnormal rotation of all or part of the stomach around one of its axes, creating the conditions of an upper abdominal obstruction with gastric dilation and risk of strangulation. It is a rare entity that requires a surgical treatment, and its diagnosis is often delayed due to frequently aspecific symptoms. We will describe the observation of a 62 year old patient who presented to the emergency department for acute epigastric pain with dyspnea. The thoracoabdominal CT has demonstrated a stasis stomach on pyloric obstacle evoking a gastric torsion. An upper gastrointestinal endoscopy (EGD) and an upper gastrointestinal contrast made it possible to diagnose an acute gastric volvulus on hiatal hernia. A midline laparotomy was performed with detorsion of the stomach and repair of the hiatal hernia. The patient recovered gradually and was discharged on the sixth postoperative day. Three months after the operation, the patient remained asymptomatic.

Bouveret-szindróma

2021 ◽  
Vol 162 (49) ◽  
pp. 1982-1986
Keyword(s):  
Gastric Outlet Obstruction ◽  
Elderly Women ◽  
Epigastric Pain ◽  
Outlet Obstruction ◽  
Abdominal Ultrasound ◽  
Therapeutic Options ◽  
Upper Gastrointestinal Endoscopy ◽  
Rare Form ◽  
Bouveret Syndrome ◽  
Upper Gastrointestinal

Összefoglaló. A Bouveret-szindróma egy bilioenteralis fistulán keresztül a vékonybélbe – az esetek 85%-ában a duodenumba – jutó nagy epekő okozta bélelzáródást jelenti. Leggyakrabban idős nők körében fordul elő. Jelen közleményünk célja e kórkép tüneteinek, diagnosztikájának és terápiás lehetőségeinek ismertetése egy esetbemutatás kapcsán. A 79 éves nőbeteg felvételi hasi panaszainak hátterében típusos gyomorkimenet-obstrukciós szindrómát okozó, a duodenumban beékelődött epekő, Bouveret-szindróma igazolódott. A diagnózist az elvégzett natív hasi röntgen és hasi ultrahangvizsgálatok már felvetették, de megerősítésére további képalkotó vizsgálatot (hasi CT) és endoszkópos beavatkozást végeztünk. Ezt követően sebészeti beavatkozás történt, melynek során a cholecystoduodenalis fistula zárása és az epekő eltávolítása után a beteg gyógyultan távozott. Közleményünkben a diagnózisfelállítás idejének fontosságáról, illetve a terápiás lehetőségekről számolunk be, valamint szeretnénk felhívni a figyelmet az epekő okozta gyomorürülési zavar ezen ritka formájára. Orv Hetil. 2021; 162(49): 1982–1986. Summary. Bouveret syndrome is a rare form of bowel obstruction resulting to the small intestine – in 85% of the cases to the duodenum – caused by a gallstone from a bilioenteral fistula. It occurs most commonly in elderly women. The aim of the present study is to describe the symptoms, diagnostic and therapeutic options of Bouveret syndrome due to our case report. The background of epigastric pain of the 79-year-old woman was the typical gastric outlet obstruction syndrome caused by Bouveret syndrome with an impacted gallstone into the duodenum. This diagnosis was suggested by abdominal X-ray and abdominal ultrasound; however, it was confirmed with abdominal computer tomography and upper gastrointestinal endoscopy. This was followed by surgical intervention to close the cholecystoduodenal fistula and remove the gallstone, finally the cured patient was discharged. In our study, we summarize the importance of timely diagnosis and therapeutic options, respectively, furthermore, draw attention to this rare form of gallstone-caused gastric outlet obstruction syndrome. Orv Hetil. 2021; 162(49): 1982–1986.

scholarly journals Medication Bezoar Causing acute Gastric Outlet Obstruction: A Case Report

2016 ◽  
Vol 33 (3) ◽  
pp. 177-180 ◽  
Author(s):  
Md Abdul Mazid
Keyword(s):  
Gastric Outlet Obstruction ◽  
Epigastric Pain ◽  
Outlet Obstruction ◽  
Uneventful Recovery ◽  
Upper Gastrointestinal Endoscopy ◽  
Abdominal Ultrasonography ◽  
Life Threatening ◽  
History Of ◽  
Upper Gastrointestinal ◽  
Made In

Medication bezoars are rare and are composed of medications and/or medication vehicles. Rarely, medication bezoars can cause serious problems due to complications such as perforation, obstruction, haemorrhage. A 60 years old woman presented with 10 days history of epigastric pain, weakness and postprandial non-bilious vomiting. Her abdominal ultrasonography showed strong post acoustic shadow noted within 1st part of duodenum possibly foreign body. Upper gastrointestinal endoscopy was performed and a bezoar of tablet of aluminum hydroxide was extracted. The patient had uneventful recovery. Acute gastric outlet obstruction is relatively uncommon and mostly due to foreign bodies related to food impaction, with meat being the most frequent culprit. The diagnostic approach to acute gastric outlet obstruction is similar to other cause of GOO. However, therapeutic options differ for each patient. The diagnosis should be made in prompt time to prevent life threatening complications due obstruction and/or effect of medication forming bezoar.J Bangladesh Coll Phys Surg 2015; 33(3): 177-180

scholarly journals Gastroduodenal Artery Pseudoaneurysm as a Complication of Pancreatitis Presenting with Lower Gastrointestinal Bleed

2021 ◽  
Author(s):  
Gursimran Nayyar ◽  
Ashish Behera
Keyword(s):  
Chronic Pancreatitis ◽  
Upper Gastrointestinal Bleeding ◽  
Gastroduodenal Artery ◽  
Unusual Complication ◽  
Coil Embolisation ◽  
Artery Pseudoaneurysm ◽  
Important Complication ◽  
Lower Gastrointestinal Bleed ◽  
Adequate Evaluation ◽  
Upper Gastrointestinal

Chronic pancreatitis is associated with an uncommon but important complication, the formation of the pseudoaneurysm with an incidence of 10%. The splenic artery is the most common artery affected by pseudoaneurysm. A 55-year-old male patient with pseudoaneurysm of the gastroduodenal artery, an unusual complication of chronic pancreatitis. He presented with haematemesisf and was managed with transfusion of blood and blood products and coil embolisation with the help of digital subtraction angiography. Pseudoaneurysms are one of the rare but important complications of chronic pancreatitis which requires treatment even if they are asymptomatic and incidentally diagnosed on imaging. A history suggestive of upper gastrointestinal bleeding in a case of pancreatitis requires adequate evaluation for source of the bleeding.

Stenting of ruptured gastroduodenal artery pseudoaneurysm

2021 ◽  
Author(s):  
Kim Que Do
Keyword(s):  
Covered Stent ◽  
Gastroduodenal Artery ◽  
Interventional Treatment ◽  
Tumor Removal ◽  
Promising Alternative ◽  
Artery Pseudoaneurysm ◽  
Acute Setting ◽  
Promising Treatment ◽  
Open Surgical Procedure ◽  
Upper Gastrointestinal

Gastroduodenal artery (GDA) aneurysm is a rare surgical entity that causes various symptoms. In the case of rupture, it usually presents an ominous prognosis and mortality rate of up to 40%. Although open surgical procedure is a mainstay, endovascular intervention is emerging a promising treatment in recent years, due to its advantages and safety. We present a case of upper gastrointestinal bleeding caused by ruptured GDA pseudoaneurysmin a 71-year-old woman, with medical episodes of acute pancreatitis, a pancreatic body tumor removal surgery was performed, and now the tumor is relapsing and metastasizing. The treatment approach is blocking off the pseudoaneurysm by a covered stent. The procedure was successful and the patient is asymptomatic. Two months later, the pseudoaneurysm reduces its size and completely excluded from the preservation of the blood flow in the artery.Follow-up to 26 month, patient is well, no symptoms or recurrence. Endovascular interventional treatment in the case of GDA aneurysms is considered a promising alternative not only to open surgery but also to an effective emerging technique even in the acute setting.

scholarly journals A challenging case of epigastric pain: diagnosis and mini-invasive treatment of a large gastroduodenal artery pseudoaneurysm

2012 ◽  
Vol 2012 (sep13 1) ◽  
pp. bcr0220125873-bcr0220125873 ◽  
Author(s):  
E. Mazza ◽  
D. Abdulcadir ◽  
C. Raspanti ◽  
M. Acquafresca
Keyword(s):  
Epigastric Pain ◽  
Gastroduodenal Artery ◽  
Invasive Treatment ◽  
Artery Pseudoaneurysm ◽  
Pain Diagnosis

scholarly journals Helicobacter pylori Infection: Clinical, Endoscopic, and Histological Findings in Lebanese Pediatric Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
F. AL Kirdy ◽  
M. Rajab ◽  
N. El-Rifai
Keyword(s):  
Helicobacter Pylori ◽  
Gastrointestinal Endoscopy ◽  
Pediatric Patients ◽  
Epigastric Pain ◽  
Demographic Data ◽  
Upper Gastrointestinal Endoscopy ◽  
Histopathological Findings ◽  
Increased Risk ◽  
H Pylori ◽  
Upper Gastrointestinal

Background. Helicobacter pylori (H. pylori) is a common and universally distributed bacterial infection. However, in children, active gastritis and ulcer are rarely seen. Objectives. The aims of this study were to establish the prevalence of H. pylori infection and to compare the clinical, endoscopic, and histopathological findings between infected and noninfected pediatric patients at Makassed General Hospital. Methods. Patients aged between 1 month and 17 years who underwent upper gastrointestinal endoscopy from January 2011 to January 2017 were included. The diagnosis of H. pylori was confirmed by a CLO test and/or its presence on biopsy specimens. Demographic data, clinical characteristics, endoscopic and histopathological findings, and gastritis score were recorded retrospectively. Results. During the study period, 651 children underwent upper gastrointestinal endoscopy. The main indication was abdominal pain (61%). The prevalence of H. pylori infection was 16.5%. The infection was most commonly seen among children aged between 6 and 10 years (43%). A large number of family members were associated with increased risk of infection (4.8±1.5 versus 5.2±1.8; p<0.05). Epigastric pain was more associated with H. pylori (61.3% versus 14.6% in noninfected patients; p<0.05). Nodular gastritis was commonly seen in infected patients (41.5% vs. 7.9%; p<0.05). Mild and moderate gastritis was seen more in infected versus noninfected patients (mild: 53.8% vs. 14%; moderate: 27.4% vs. 2.4%, respectively). Conclusion. Although epigastric pain was associated with H. pylori, other diagnoses should be considered since the infection are rarely symptomatic in children. Antral nodularity was associated with H. pylori infection; however, its absence does not preclude the diagnosis.

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