Abstract
A 61-year-old man presented to a general hospital with a chief complaint of hematemesis. Upper gastrointestinal endoscopy was carried out which detected an ulcerative lesion in the duodenum. Abdominal computed tomography (CT) scan revealed a gastroduodenal artery (GDA) aneurysm. The patient was in hemorrhagic shock and referred to our hospital with a diagnosis of ruptured GDA aneurysm. On blood examination, his hemoglobin had dropped to 6.1 g/dl. Further, contrast enhanced CT showed a GDA aneurysm (55×45 mm) above the head of the pancreas. CT angiography dispalyed a spindle-shaped aneurysm at the bifurcation of the common hepatic artery. Transcatheter arterial embolization (TAE) seemed to be difficult in this case, which led us to decide on an emergency pancreatoduodenectomy. During the operation the rebleeding from the aneurysm caused a sudden drop in blood pressure. Eventually we controlled the hemorrhage by ligating the GDA and inferior pancreaticoduodenal artery.
The GDA aneurysm is a rare entity, which accounts for only 0.5% of all abdominal aneurysms. GDA aneurysm rupture may be life-threatening and carries a poor prognosis. Although TAE is the first choice, emergency open surgery may be warranted and always should be considered as a life-saving procedure.
