Effects of vasopressin infusion aided prophylactic gastroduodenal artery embolization in DSA-negative gastrointestinal bleeding patients

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.

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2386 Shock Liver: A Complication of Gastroduodenal Artery Embolization

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000599076.60435.fe ◽

2019 ◽

Vol 114 (1) ◽

pp. S1325-S1325 ◽

Cited By ~ 1

Author(s):

Faiza Husain ◽

Ahmad Dwairy ◽

John Che ◽

Mohamad El Zein ◽

Ali Nawras ◽

...

Keyword(s):

Gastroduodenal Artery ◽

Artery Embolization ◽

Shock Liver

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Pseudoaneurysm of gastroduodenal artery due to duodenal ulcer causing jaundice and interstitial pancreatitis but not gastrointestinal bleeding

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0404108j ◽

2004 ◽

Vol 132 (3-4) ◽

pp. 108-111 ◽

Cited By ~ 2

Author(s):

Miodrag Jovanovic ◽

Radoje Colovic ◽

Nikica Grubor ◽

Mirjana Perisic ◽

Vladimir Radak

Keyword(s):

Duodenal Ulcer ◽

Gastrointestinal Bleeding ◽

Heavy Drinking ◽

Gastroduodenal Artery ◽

Operative Trauma ◽

Billroth Ii Gastrectomy ◽

Successful Recovery ◽

Pseudo Aneurysm ◽

Alcohol Consumer ◽

Postbulbar Duodenal Ulcer

Aneurysms and pseudoaneurysms of the gastroduodenal artery are rare with less then 50 cases reported. Most frequently they are one of the consequences of pancreatitis much rarer duodenal ulcer or operative trauma during gastrectomy for duodenal ulcer or choledochotomy. We report on a 47 year-old man, chronic heavy alcohol consumer in whom a chronic postbulbar duodenal ulcer destroyed much of the back wall of the duodenum, eroded gastroduodenal artery causing pseudo-aneurysm but without noticeable gastrointestinal bleeding. The patient had jaundice of obstructive type and elevated amilase. After Billroth II gastrectomy, suture of the gastroduodenal artery, cholecystectomy and T tube drainage of the common bile duct the patient developed intestinal obstruction caused by two interintestinal abscesses so that he had to be reoperated. After that he had a successful recovery, his general health greatly improved, he gained 15 kg in weight but two years after surgery he again started with heavy drinking and soon died due to serious brain damage. The case is rare and unusual at least for few reasons: First, the pseudoaneurysm was caused by duodenal ulcer. Second, a serious gastrointestinal bleeding did not take place. Third, the pseudoaneurysm was diagnosed by Doppler ultrasonography while angiography failed to opacity it due to thrombosis of the artery.

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