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 / Reparo endovascular duplo (molas e stent) de aneurisma verdadeiro da artéria gastroduodenal

Abstract 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.

Resumo Relatamos um caso de aneurisma de artéria gastroduodenal assintomático diagnosticado em uma mulher de 39 anos. Uma ultrassonografia abdominal mostrou uma dilatação aneurismática associada à artéria gastroduodenal com 2 x 2 cm de diâmetro. Para confirmar esse achado, foi realizada uma tomografia computadorizada do abdome e da pelve, que revelou um aneurisma sacular da artéria gastroduodenal. Uma abordagem endovascular dupla foi utilizada para exclusão do aneurisma mediante embolização com molas assistida por stent. A exclusão completa do saco aneurismático foi confirmada na angiografia final. A paciente recebeu alta hospitalar no primeiro dia de pós-operatório.

Delayed Hemorrhage from Gastroduodenal Artery Pseudoaneurysm following Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Head Mass / 대한췌담도학회지

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a well-established procedure for the diagnosis of pancreatobiliary disease. Serious complications such as perforation, pancreatitis, hemorrhage, and sepsis are rarely reported. To our knowledge, delayed hemorrhage after EUS-FNA is very rare and hemorrhage from iatrogenic pseudoaneurysm has yet to be reported. We report a case of delayed hemorrhage from gastroduodenal artery pseudoaneurysm, which developed after EUS-FNA of a solid pancreatic lesion. A 68-year-old man presented with tarry stool 10 days after EUS-FNA of a 1.5 cm-sized pancreatic head mass. Abdominal computed tomography showed a 2-cm-sized intensely enhancing round lesion near pancreatic head. EUS-FNA was negative for malignancy. The patient refused admission for further evaluation. Twelve days later, he reported to the emergency room with persistent tarry stool. Angiography showed a gastroduodenal artery pseudoaneurysm. Subsequent coil embolization resulted in successful hemostasis. The patient underwent pylorus-preserving pancreaticoduodenectomy and was diagnosed with stage IIB pancreatic cancer.

Variations in Origin of Gastroduodenal Artery: A Cadaveric Study.

Background: Gastroduodenal artery (GDA) is usually the first branch of the common hepatic artery from celiac trunk. In patients with chronic pancreatitis visceral artery aneurysms, incidence of up to 10% has been reported. The aneurysms occur most frequently in the splenic artery (10.4%); the common hepatic, gastroduodenal (1.5%), and pancreaticoduodenal arteries are affected. Material and Methods: It was a cross-sectional study conducted in the Department of General Surgery and Forensic Medicine, N.S.C.B. Medical College, Jabalpur during the period from August 2012 to August 2013. Abdomen of the cadaver will be accessed by the standard postmortem midline incision (sternum to pubes). Vascular anatomy of the GDA and vein will be dissected out in-situ using standard surgical instruments. The distance from the pylorus to the GDA will be measured by measuring tape. Results: In our study, out of total 31 cadavers, 19 (61.2%) were of male and 12 (38.8%) were of females. In all the cases, the site of origin of GDA is from the celiac axis of the common hepatic artery. Out of total 19 male cadavers, 17 (89%) showed a distance of 2.5-3 cm between pylorus and GDA and remaining 2 (11%) showed a distance of 3-3.5 cm. Conclusion: In our study, GDA has been seen arising from common hepatic artery from the celiac axis in 100% of cases. Previous studies have also given very less percentage of rare sites of origin but with the advent of newer modalities of investigations such as Doppler studies and computed tomography angiograms this very less percentage of rare variations can be diagnosed if there are knowledge and suspicion. This will help a lot to prevent major catastrophe during surgeries and radiological interventions.

The display of the artery located at anterolateral region next to pancreatic head on enhanced CT and its clinical significance / 实用放射学杂志

Objective To observe the display and source of the artery located at anterolateral region next to pancreatic head on en-hanced CT,and to investigate its clinical value.Methods Imaging data of 200 consecutive patients who underwent abdominal CT scan were collected,and their CT images were analyzed.The reconstructed images were obtained at a post-processing workstation. After reconstruction,the display rate,source and branches of the artery located at anterolateral region next to pancreatic head were analyzed,and the diameters of these vessels were measured.Results The arterial vessel located at anterolateral region next to pan-creatic head was found on axial CT image in arterial phase with a display rate of 100%.By using post-reconstruction images,most vessels were gastroduodenal artery with mean diameter of 0.33 cm± 0.05 cm,and other ones were pancreaticoduodenal artery or right gastroomental artery.Conclusion The artery located at anterolateral region next to pancreatic head can be found on axial ab-dominal CT image in the arterial phase.Most vessels are gastroduodenal artery with a fixed position and traveling.

Anomalous origin of cystic artery from gastroduodenal artery: a case report / Origen nnómalo de la arteria cística desde la arteria gastroduodenal: reporte de un caso

The knowledge of vascular variations, like other anatomical variations, is important during the operative, diagnostic and endovascular procedures in abdomen. Variations in the branching pattern of the common hepatic artery often occur and may be encountered during cholecystectomy. This report describes a variation in the origin of cystic artery from the gastro duodenal artery as found during routine dissection in an approximately 34 years old male cadaver. The embryological development and clinical implications of such a variant have been discussed in the article.

El conocimiento de las variaciones vasculares, al igual que otras variaciones anatómicas, son importantes durante los procedimientos operativos, diagnósticos y endovasculares en el abdomen. Variaciones en el patrón de ramificación de la arteria hepática común se producen con frecuencia y pueden ser encontradas durante la colecistectomía. Este informe describe una variación en el origen de la arteria cística desde la arteria gastroduodenal encontrada durante la disección de rutina, en un cadáver de sexo masculino, de aproximadamente 34 años. El desarrollo embriológico y las implicaciones clínicas de esta variante son debatidas en el artículo.

Embolization of Gastroduodenal Artery Aneurysmal Rupture Caused by Chronic Pancreatitis / 대한내과학회지

Gastrointestinal hemorrhage is a recognized complica tion of chronic pancreatitis and has been reported to occur in up to 20% of cases. Visceral vessel aneurysm such as gastroduodenal artery aneurysm associated with chronic pancreatitis is rare but clinically important vascular lesion because it carries a high mortality, making early diagnosis and treatment essential. The conventional treatment has been surgical liga tion or resection of aneurysm which is associated with high mortality and morbidity. So transarterial emboliza tion has been used recently in preference to surgery to stop the hemorrhage from this aneurysm. We report a case in which bleeding from a gastroduo denal artery aneurysm, caused by chronic pancreatitis, was successfully treated by embolization using a metallic micro coil.

Animal study on the feasibility of regional gastroduodenal artery or splenic artery ligation followed by regional intraarterial perfusion of pancreas with 5-FU / 中国癌症杂志

Background and Purpose:Pancreatic cancer is malignant tumor of the digestive tract with poor prognosis and is not sensitive to conventional chemotherapy.This study investigates the safety and feasibility of regional arterial ligation followed by intra-arterial perfusion chemotherapy in 14 pigs divided into groups A,B and C.Methods:14 pigs were divided into 3 groups.Group A(n=5) underwent gastroduodenal artery ligation and catheterization through the right gastroepiploic artery.Group B(n=5) underwent splenic artery ligation and catheterization.Group C(n=4) underwent left periotic vein puncture.5-FU(20mg/kg) was perfused into these catheters in 60 min.Blood samples and pancreatic tissue were obtained for the purposes of the determination of drug concentration and pathological diagnosis.Results:At 80 min and 100 min the drug concentration in portal vein of group A and group B were higher than those of group C(P

Study of the arterial blood supply of the pancreas head and the gastroduodenal artery reconstruction of pancreatic graft / 中国普通外科杂志

Objective To investigate the arterial blood supply of the pancreas head and provide a theoretical basis for the gastroduodenal artery reconstruction in pancreatic transplantation(PT).Methods Photograms of digital subtraction artery(DSA)which performing on 300 patients were analyzed to recognize the aberrations of arterial blood supply of pancreatic head.Results In 300 DSA photograms,the gastroduodenal artery(GD.a)was identified in 131 cases,and the anterior superior pancreaicduodenal artery(ASPD.a)and posterior superior pancreaicduodenal artery(PSPD.a)in 79 cases.The rate of aberrant origin of pancreatic transverse artery(PT.a)from GD.a was 12.98℅.There are some minor sources of blood supply to the pancreas head from GD.a.The rate of absence of an ASPD.a-AIPD.a anastomosis and PSPD.a-PIPD.a anastomosis was 15.19℅and 24.05℅,respectively.Conclusions The reconstruction of gastroduodenal artery can ensure a complete blood supply to the pancreatic head and duodenum in PT.