Gastroduodenal artery pseudoaneurysm

A 49-year-old man with a history of chronic alcoholism, post-traumatic subarachnoid haemorrhage and upper gastrointestinal bleeding eight years previously. He visited the A&E department with overt gastrointestinal bleeding in the form of melaena and later haematemesis and rectal bleeding. Once the patient was stabilised, an urgent gastroscopy was performed (incomplete due to abundant blood residue). The examination was repeated 12 h later, showing a large duodenal ulcer actively oozing blood and a visible vessel (Fig. 1), which was sclerosed with adrenaline and Aethoxysklerol. A CT angiogram was then performed (Fig. 2), showing a pseudoaneurysmal dilation of the gastroduodenal artery in a possible duodenal ulcer bed which was treated by embolisation.

Fig. 1.

Endoscopic image of visible vessel on ulcer bed.

Fig. 2.

Sector image in arterial phase of CT angiography: gastroduodenal artery pseudoaneurysmal dilation.

After absconding from hospital, the patient was readmitted five days later in haemorrhagic shock. A repeat CT angiogram was performed, which ruled out active bleeding, and two further gastroscopies, showing a Forrest IIc duodenal ulcer that was treated with sclerosing agent. Given the persistence of his anaemia, he was finally operated on.

Gastroduodenal artery pseudoaneurysms usually present with haematemesis and/or melaena which appear after chronic inflammation, sometimes associated with chronic pancreatitis.¹ Endoscopic visualisation is rare and a computed tomography (CT) scan is generally required for diagnosis. A multidisciplinary approach is required², which includes embolisation³ as the first line of treatment and surgery if that fails.

Conflicts of interest

The authors have no conflicts of interest to declare.