POST CYSTOGASTROSTOMY BLEEDING-COMMON COMPLICATION UNUSUAL CAUSE: A CASE REPORT

Pseudoaneurysms of gastroduodenal artery are rare and mostly associated with pancreatitis. We report a case of a ruptured GDA aneurysm in a patient who underwent cystogastrostomy for pancreatic pseudocyst and this has rarely been reported in the literature. Our patient presented with hematemesis 2 week postoperatively. CT angiogram showed pseudoaneurysm of the GDA and which was embolised. Our case highlights that GDA aneurysm must be considered in the differential for a patient who presents with upper GI tract bleed after drainage of pancreatic pseudocyst and that it can be managed with angioembolization. A 30 year old male presented to our surgery department with a four-month history of pain & swelling over upper abdomen with associated vomiting. CT scan showed large thicked walled cystic lesion in lesser sac abutting the uncinate process with atrophy of body and tail of pancrease s/o chronic pancreatitis with pseudocyst formation. We performed cystogastrostomy for pancreatic pseudocyst. Two week later, he presented with the complains of hematemesis. Patient was resuscitated initially and then CT angiogram was planned that showed pseudoaneurysm of the GDA. The pseudoaneurysm was embolised and patient was sent home later on. Gastroduodenal artery aneurysm shoud be suspected in a patient with GI hemorrhage after surgery for Pancreatic pseudocyst. The investigation of choice is CT angiography and endovascular angioembolisation is the treatment modality of choice.

A rare case of gastroduodenal artery aneurysm in a highly active antiretroviral therapy induced acute pancreatitis case presenting with lump in abdomen

Gastroduodenal artery (GDA) aneurysm is a rare but potentially fatal vascular disease, with chronic pancreatitis being reported as the commonest etiological factor. Rupture, which is not uncommon, carries a high risk of mortality. The typical patient with palpable epigastric mass, upper gastrointestinal bleeding and pain, may not present in the emergency and the lesion is often picked up incidentally on abdominal ultrasound or a computed tomography. We describe a critical case presenting with lump in abdomen which was found out to be gastroduodenal artery aneurysm on scanning, developing in a patient with recurrent highly active antiretroviral therapy (HAART) induced pancreatitis managed with transfemoral catheter embolization. The patient in question succumbed due to post procedure hepatic failure. The management of aneurysms since historic times have been challenging, the open procedures are being gradually replaced by endovascular techniques, which are yielding better results.

Dual endovascular repair (coils and stent) of a true aneurysm of the gastroduodenal artery

We report a case of an asymptomatic gastroduodenal artery aneurysm diagnosed in a 39 year-old woman. An abdominal ultrasound study showed an aneurysmal dilatation of the gastroduodenal artery with 2 x 2 cm diameter. To confirm this finding, she then underwent a computed tomography scan of the abdomen and pelvis that showed a saccular aneurysm of the gastroduodenal artery. A dual endovascular approach was used to exclude the aneurysm by stent-assisted coil embolization. Complete exclusion of the aneurysm sac was confirmed on final angiography. She was discharged from the hospital on postoperative day 1.

Upper Gastrointestinal Bleed: Do not Forget a Look at Ampulla

Hemosuccus pancreaticus (HP) and hemobilia (HB) are uncommon causes of upper gastrointestinal bleed. In this report, 4 cases of HP and 1 case of HB with intermittent bleeding are described. The causes of HP are rupture of splenic artery pseudoaneurysm in 3 and gastroduodenal artery aneurysm in one. The cause of HB is due to cystic artery bleed. HP can be secondary to chronic or acute pancreatitis with bleeding from pseudoaneurysm arising from peripancreatic arteries. Iatrogenic transhepatic techniques, trauma, operative injuries, malignancy, and inflammation in hepatobiliary system are the common causes of HB. All the cases are missed on first endoscopy and diagnosed on second‑look endoscopy. A strong clinical suspicion is required at first endoscopy for early diagnosis and management. This case report compares presentation of HP with HB, diagnosis, and their management.