An Unusual Anatomical Variation of Accessory Left Gastric Artery Arising from Left Hepatic Artery / Una Variación Anatómica Inusual de la Arteria Gástrica Izquierda Accesoria que se Origina de la Arteria Hepática Izquierda

SUMMARY: The stomach receives a rich blood supply from five sets of arteries, all of which originate from the celiac trunk. During the dissection of a female cadaver that had been fixed with formalin, an atypical branching pattern was observed. An accessory left gastric artery was found to originate from the left hepatic artery and send small branches to the esophagus, cardia, and fundus of the stomach. However, there was no anastomosis between the lower accessory left gastric artery and the left gastric artery. This is a rare variant of the gastric artery that has not been previously described in detail. It is important to recognize this variation for safe and effective interventional diagnosis and treatment techniques if dealing with the liver or gastric arteries.

El estómago recibe un rico suministro de sangre de cinco conjuntos de arterias, todas las cuales se originan en el tronco celíaco. Durante la disección de un cadáver femenino que había sido fijado con formalina, se observó un patrón de ramificación atípico. Se encontró una arteria gástrica izquierda accesoria que se originaba en la arteria hepática izquierda y enviaba pequeñas ramas al esófago, el cardias y el fondo del estómago. Sin embargo, no hubo anastomosis entre la arteria gástrica izquierda accesoria inferior y la arteria gástrica izquierda. Se trata de una variante rara de la arteria gástrica que no se ha descrito previamente en detalles. Es importante reconocer esta variación para la aplicación de técnicas de diagnóstico y tratamiento intervencionistas seguras y efectivas a nivel del hígado o las arterias gástricas.

Embolización de la arteria gástrica izquierda: un novedoso procedimiento para el tratamiento de la obesidad / Left gastric artery embolization: a novel procedure for the treatment of obesity

Introducción: La embolización de la arteria gástrica izquierda, es una técnica novedosa, mínimamente invasiva que se investiga como un método alternativo, a menudo complementario, para controlar el apetito y el peso corporal a través de la reducción de la secreción de la hormona grelina. Objetivo: Describir la seguridad y la eficacia de la embolización de la arteria gástrica izquierda, como procedimiento terapéutico para el tratamiento de la obesidad. Método: Se realizó una búsqueda de literatura relevante sobre el tema en el segundo semestre de 2019. Se utilizaron como buscadores de información científica a Pubmed y a Google Académico; se revisaron 54 artículos, de los cuales 36 fueron referenciados. Conclusiones: La seguridad y la eficacia de la embolización de la arteria gástrica izquierda como proceder terapéutico para el tratamiento de la obesidad fue aceptable en la mayoría de los estudios revisados; la escasez de la evidencia (pocos casos) y la falta de protocolos estandarizados para esta intervención, requieren de ensayos clínicos aleatorizados, con una muestra mayor de casos y a más largo plazo.

Introduction: left gastric artery embolization is a novel, minimally invasive technique that is being investigated as an alternative method, often complementary, to control appetite and body weight by means of reducing the secretion of the ghrelin hormone. Objective: to describe the safety and efficacy of left gastric artery embolization as a therapeutic procedure for the treatment of obesity. Methods: a review of the relevant literature on the subject was carried out in the second semester of 2019. Pubmed and Google Scholar were used as scientific information search engines; 54 articles were reviewed, of which 36 were referenced. Conclusions: the safety and efficacy of left gastric artery embolization as a therapeutic procedure for the treatment of obesity was acceptable in most of the reviewed studies; the lack of evidence (few cases) and standardized protocols for this intervention require randomized clinical trials, with a larger sample of cases and over a longer period of time.

Morphological characteristics of the left gastric, common hepatic and splenic arteries. A descriptive study in human cadaveric specimens / Características morfológicas das artérias gástricas esquerda, hepática comum e esplênica. Um estudo descritivo em espécimes cadavéricos humanos

ABSTRACT Objective: to evaluate the morphology of the branches of celiac trunk (CT), left gastric (LGA), common hepatic (CHA), and splenic (SA) arteries in cadaveric specimens from a sample of a Colombian population. Methods: descriptive cross-sectional study of 26 blocks from the abdominal upper segment of human cadavers who underwent forensic autopsies at the Instituto de Medicina Legal at Bucaramanga, Colombia. The vascular beds of the celiac trunk were, subsequently, perfused with a semi-synthetic resin. Results: the diameters of LGA, CHA, and SA were 3.6±0.8mm, 5,2±1.2mm, and 5.9±1.0mm, respectively. Statistically, LGA and SA were different (p=<0.001). SA followed a linear trajectory in 8 (31%) samples, slightly tortuous in 4 (15%), and tortuous in 14 (54%). The tortuosity index was 1.25±0.18. Of the branches of CHA, the proper hepatic artery (PHA) had 4.8±1.2mm in diameter and 18.8±9.1mm in length, whereas the gastroduodenal artery (GDdA) had 4.1±0.8mm. In 2 cases (7.7%), an accessory hepatic artery from the LGA was found to supply perfusion to the left hepatic lobe. Finally, in 2 cases (7.7%) the SA came independently from the abdominal aorta. Conclusion: the observed emergence incidence of the CT branches from the same level as reported in the literature is lower. The characterization, along with their variants, of LGA, CHA, and SA must be considered in surgical procedures in the upper abdominal segment, to avoid iatrogenic complications.

RESUMO Objetivo: avaliar a morfologia dos ramos das artérias do tronco celíaco (CT), gástrica esquerda (LGA), hepática comum (HC) e esplênica (SA) em espécimes cadavéricos de uma amostra de uma população colombiana. Métodos: estudo transversal descritivo de 26 blocos do segmento superior abdominal de cadáveres humanos submetidos a necropsias forenses no Instituto de Medicina Legal de Bucaramanga, Colômbia. Os leitos vasculares do tronco celíaco foram, posteriormente, perfundidos com resina semissintética. Resultados: os diâmetros de LGA, CHA e SA foram 3,6±0,8mm, 5,2±1,2mm e 5,9±1,0mm, respectivamente. Estatisticamente, LGA e SA foram diferentes (p=<0,001). A SA seguiu uma trajetória linear em 8 (31%) amostras, levemente tortuosa em 4 (15%) e tortuosa em 14 (54%). O índice de tortuosidade foi de 1,25±0,18. Dos ramos do ACS, a artéria hepática própria (APH) tinha 4,8±1,2mm de diâmetro e 18,8±9,1mm de comprimento, enquanto a artéria gastroduodenal (GDdA) tinha 4,1±0,8mm. Em 2 casos (7,7%), uma artéria hepática acessória do GIG foi encontrada para fornecer perfusão ao lobo hepático esquerdo. Finalmente, em 2 casos (7,7%) a SA veio independentemente da aorta abdominal. Conclusão: a incidência observada de emergência dos ramos de TC do mesmo nível relatado na literatura é menor. A caracterização, juntamente com suas variantes, de LGA, CHA e SA deve ser considerada em procedimentos cirúrgicos no segmento abdominal superior, para evitar complicações iatrogênicas.

Histopathological and immunohistochemical changes of gastric fundus and duodenum after bariatric embolization in the New Zealand rabbits / 中华放射学杂志

Objective:To investigate the histopathological and immunohistochemical changes of gastric fundus and duodenum after bariatric embolization of left gastric artery and gastroduodenal artery in obesity New Zealand rabbit models.Methods:Twenty obesity New Zealand rabbit models were successfully established and divided into two groups using stratified randomization. Left gastric artery and gastroduodenal artery were embolized with gelatin sponge (350-560 μm) in experimental group, left gastric artery and gastroduodenal artery were perfused with normal saline in control group. All animals were sacrificed for pathological, immunohistochemical examination and Western Blot analysis 4 weeks post embolization, the density of ghrelin producing cells and the gray ratio of ghrelin protein band were measured and compared by the independent sample t test. Results:Macropathological examination showed ulceration in the anterior wall of the gastric body in one rabbit, histopathological examination showed mucosa ulceration in the gastric body in 3 rabbits in experimental group. Immunohistochemical examination showed that the ghrelin producing cells of gastric fundus and duodenum in the experimental group were significantly less than those in the control group (10.0±5.1 vs.27.7±3.4, t=12.35, P<0.05;5.6±2.6 vs. 12.3±2.1, t=4.73, P<0.05). Western Blot analysis showed that the gray ratio of ghrelin bands of gastric fundus and duodenum in the experimental group were significantly lower than that in the control group (0.65±0.05 vs.1.12±0.09, t=9.62, P<0.05;0.55±0.03 vs. 0.94±0.08, t=7.98, P<0.05). Conclusions:Immunohistochemical and Western Blot analysis showed that the ghrelin-producing cells of gastric fundus and duodenum in the experimental group were significantly less than those in the control group after bariatric embolization, histopathologic analysis indicated that bariatric embolization was a safe technique.

Evaluación anatómica del tronco celíaco y sus ramas en una muestra de población mestiza colombiana / Anatomical evaluation of the celiac trunk and its branches in a sample of Colombian mestizo population

RESUMEN: El tronco celíaco (TC) es la rama de la arteria aorta abdominal (AA) que aporta la irrigación a la porción distal del esófago, parte media del duodeno, al estómago, páncreas, bazo y suple adicionalmente al hígado; sus diferentes expresiones anatómicas son reportadas en los diferentes grupos poblacionales con incidencia variable. Se evaluó las características morfológicas del TC y sus ramas en 26 bloques del piso supramesocólico de cadáveres masculinos adultos no reclamados, del grupo poblacional mestizo, a quienes se les practico autopsia en el Instituto de Medicina Legal de Bucaramanga - Colombia. Se observo el tipo I del TC en 23 especímenes (88,4 %), del cual correspondió 16 muestras (61,5 %). Al subtipo Ia con bifurcación y formación de tronco hepatoesplénico. Hubo un caso (3,8 %) en donde las ramas del T se originaron de manera independiente de la AA. El TC presentó una longitud promedio de 18,6 DE 7,53 mm y un diámetro externo de 7 DE 1,24 mm. De las ramas del TC, la AE presentó un diámetro promedio de 5,89 DE 1,04 mm sin diferencias estadísticamente significativa con relación al diámetro de la AHC, pero si con relación al diámetro de la AGI (P= 0,70; p<0,001 respectivamente). La gran mayoría de la muestra avaluada muestra la presencia de tronco hepatoesplénico seguido de la trifurcación en una verdadera configuración de trípode. El conocimiento de los patrones de ramificación del TC debe ser tomado en cuenta por cirujanos gastroenterólogos, radiólogos intervencionistas y oncólogos para evitar complicaciones durante los procedimientos quirúrgicos abdominales.

SUMMARY: The celiac trunk (CT) is the branch of the abdominal aorta artery (AA) that provides irrigation to the distal portion of the esophagus, the middle part of the duodenum, the stomach, pancreas, spleen and additionally supplies the liver; its different anatomical expressions are reported in the different population groups with variable incidence. The morphological characteristics of the CT and its branches were evaluated in 26 blocks of the supramesocolic floor of unclaimed adult male corpses, of the mestizo population group, who were autopsied at the Institute of Legal Medicine of Bucaramanga - Colombia. Type I CT was observed in 23 specimens (88.4 %), of which 16 samples (61.5 %) corresponded. to subtype Ia with bifurcation and formation of the hepatosplenic trunk. There was one case (3.8 %) in which the branches of the CT originated independently of the AA. The CT had an average length of 18.6 SD 7.53 mm and an external diameter of 7 SD 1.24 mm. Of the CT branches, the splenic artery presented an average diameter of 5.89 SD 1.04 mm without statistically significant differences in relation to the diameter of the AHC, but if in relation to the diameter of the IGA (P = 0.70; p <0.001 respectively). The vast majority of the sample evaluated shows the presence of a hepatosplenic trunk followed by trifurcation in a true tripod configuration. Knowledge of CT branching patterns should be taken into account by gastroenterological surgeons, interventional radiologists, and oncologists to avoid complications during abdominal surgical procedures.

Rare Origin of Accessory Left Gastric Artery from Splenic Artery and Its Clinical Significance: A Case Report

During routine dissection of abdomen an accessory leftgastric artery was found arising from the splenic arteryin one out of 30 adult formalin fixed cadavers in theDepartment of Anatomy, Kasturba Medical CollegeManipal. The origin of left gastric artery was normal.The accessory artery was running upwards behind usualleft gastric artery and run along lesser curvature of thestomach and also gave oesophageal branch supplyingthe lower part of esophagus. Before attempting anysurgical procedure on stomach or lower end ofoesophagus, preoperative evaluation of the arterialpattern and variations is desirable for correct surgicalapproach and to reduce postoperative complications.However, accessory left gastric origin from splenicartery becomes important to be noted when the patientundergoes angiography for diagnostic bleeding orduring trans catheter therapy. Knowledge about thesevariations is also important to be noted prior to surgeryin order to prevent postoperative complications whichwould be fatal.

Abdominal Apoplexy after Pulmonary Lobectomy for Lung Cancer / Apoplejía abdominal tras una lobectomía pulmonar por cáncer de pulmón

ABSTRACT Abdominal apoplexy is a rare clinical entity, and its clinical manifestations are diverse. This case report is of a 52-year-old man who developed right upper abdominal pain with unstable haemodynamics 32 hours after right upper pulmonary lobectomy for lung carcinoma. Abdominal computed tomography showed a ruptured right gastric artery aneurysm.

RESUMEN La apoplejía abdominal es una entidad clínica rara, y sus manifestaciones clínicas son diversas. Este es un reporte de caso de un hombre de 52 años que presentó dolor abdominal superior derecho con hemodinámica inestable, 32 horas después de una lobectomía pulmonar superior derecha por carcinoma del pulmón. La tomografía computarizada abdominal mostró una ruptura de aneurisma de la arteria gástrica derecha.

MSCT angiography in typing variations in origins of left gastric artery / 中国介入影像与治疗学

Objective To explore the types of variations in the origin of left gastric artery (LGA) using MSCT angiography.Methods The abdominal MSCT angiography data of 1 500 patients were respectively reviewed,in thoses the abdominal aorta,celiac trunk,LGA,common hepatic artery (CHA),splenic artery (SA) and superior mesenteric artery (SMA)were shown clearly.The origins of the LGA and related artries were focused.A new typing method (types Ⅰ-Ⅹ) was established.And the incidence of various types was calculated.Results The normal anatomical origin (type Ⅰ) of LGAwas noted in 1 342 cases (1 342/1 500,89.47％).Eight types of LGA variant origin were identified in 70 cases (70/1 500,4.67％).LGA variant origin combined with celiomesenteric trunk (CMT) were observed in 47 cases (47/1 500,3.13％).The most common type of LGA origin variation was LGA originated from the abdominal aorta combined with CMT (type Ⅴ) which was found in 24 cases (24/1 500,1.60％).And the least common type was the namely LGA,SA,CHA and SMA arose independently from abdominal aorta (type Ⅵ) which was found in 3 cases (3/1 500,0.20 ％).LGA originated from SMA (type Ⅷ) was not found in all 1 500 cases.Conclusion There are many kinds of variations in the origin of LGA.The new typing method can contribute the comprehensive and intensive data for understanding the anatomical and radiographic features.

MSCT angiography in typing variations in origins of left gastric artery / 中国介入影像与治疗学

Objective To explore the types of variations in the origin of left gastric artery (LGA) using MSCT angiography.Methods The abdominal MSCT angiography data of 1 500 patients were respectively reviewed,in thoses the abdominal aorta,celiac trunk,LGA,common hepatic artery (CHA),splenic artery (SA) and superior mesenteric artery (SMA)were shown clearly.The origins of the LGA and related artries were focused.A new typing method (types Ⅰ-Ⅹ) was established.And the incidence of various types was calculated.Results The normal anatomical origin (type Ⅰ) of LGAwas noted in 1 342 cases (1 342/1 500,89.47％).Eight types of LGA variant origin were identified in 70 cases (70/1 500,4.67％).LGA variant origin combined with celiomesenteric trunk (CMT) were observed in 47 cases (47/1 500,3.13％).The most common type of LGA origin variation was LGA originated from the abdominal aorta combined with CMT (type Ⅴ) which was found in 24 cases (24/1 500,1.60％).And the least common type was the namely LGA,SA,CHA and SMA arose independently from abdominal aorta (type Ⅵ) which was found in 3 cases (3/1 500,0.20 ％).LGA originated from SMA (type Ⅷ) was not found in all 1 500 cases.Conclusion There are many kinds of variations in the origin of LGA.The new typing method can contribute the comprehensive and intensive data for understanding the anatomical and radiographic features.

Behavioral Anatomy of the Celiac Trunk Based on Human Embryology.

Anatomical knowledge of the coeliac trunk and its branches is indispensable for surgeons in order to avoid post-surgery complications and malpractice and that’s what inspired us to review this important topic. The coeliac trunk is the first ventral branch of arising from the abdominal aorta below the aortic opening of diaphragm. It is responsible for the blood supply of the not only the foregut but also for accessory organs of gastrointestinal tract (GIT) which include liver, pancreas and biliary apparatus [1]. Anatomic variations are often responsible for a variety of clinical conditions and it’s often occurring in the coeliac trunk branches.

Cadaveric Study of Varoations in Branching Pattern of Splenic Artery.

Introduction: Splenic artery was previously called as Lineal artery. Splenic artery is the largest branch of the celiac trunk and is the most tortuous artery in the body. Splenic artery mainly supplies spleen and gives off branches to the stomach and the pancreas. Splenic artery divides into terminal branches before entering into the hilum of the spleen which may be Magistral or Distributed type. Sometimes it may pass through the hilum without dividing and supplies the spleen. Materials and methods: The study was done on 50 embalmed cadavers during routine dissection practices for undergraduates in the dissection hall of Gandhi Medical College, Secunderabad, and from the Department of Anatomy Osmania medical college, Hyderabad, during the period of 3years.The variations in the branching pattern of the splenic artery was observed and photographed. The prime objective of the study is to compare the prevalence of variations in the branching pattern of splenic artery. Results and conclusion: The variations in the present study were almost correlated with the available literature. In some instances the left gastro epiploic artery, the posterior gastric artery and the accessory left gastric artery took origin from the interior of spleen. so care should be taken during splenectomy. Hence, the arterial blood supply of spleen is so varied that no two vascular patterns are ever the same.

Laparoscopic sleeve excision of lesser curvature gastrointestinal autonomic nerve tumour.

Gastrointestinal autonomic nerve tumors (GANT) are uncommon stromal tumors of the intestinal tract. Their histological appearance is similar to that of other gastrointestinal stromal tumors. We report probably the first laparoscopic excision of this rare tumor from our geographical region and compare our findings with the available case reports in the medical literature. A 38 year old male patient undergoing a routine health check was diagnosed with an exophytic growth on the lesser curvature of stomach on computerized tomography and underwent an initial endoscopic biopsy which was inconclusive. He underwent a laparoscopic sleeve excision of the GANT on the lesser curvature. Radical surgical resection of gastrointestinal autonomic nerve tumors seems to be the only available curative approach and survival seems possible even in large tumors.

Multiple variations in the branches of the coeliac trunk / 대한해부학회지

Here we present a unique case of variation in the branching pattern of the coeliac trunk. In the present case, the coeliac trunk was replaced by two separate arterial trunks. The first arterial trunk bifurcated into the left gastric and the left hepatic arteries. The second arterial trunk bifurcated into a splenic artery and a hepato-gastroduodenal trunk. The hepato-gastroduodenal trunk presented an unusual course and termination. The right hepatic artery arising from the hepato-gastroduodenal trunk also showed a variant course. Such rare variations are important for gastroenterological surgeons and interventional radiologists due to increase in number of transplantation surgeries and live donor liver transplantations.

A study of morphology of coeliac trunk in 100 cadavers.

Background: The coeliac trunk is an integral part of the circulatory system as it delivers blood from the heart to major organs within the abdominal cavity. The blood that it delivers is oxygenated and carries essential nutrients and immune system particles that can aid in life sustaining processes and can also prevent the development of diseases and complications from illnesses. Aims & Objective: (1) To study the anatomy of coeliac trunk, through its diameter, length related to their branches and distance from superior mesenteric artery. (2) To study the clinical implication of coeliac trunk in case of the variations and anomalous formation of coeliac trunk. Material and Methods: Morphology of coeliac trunk was studied in 100 formalin embalmed cadaver, aged between 50 to 80 years. Dissection method was use for this study. Results: Measurement of the length of the coeliac trunk up to the left gastric, Measurement of the length of coeliac trunk up to common hepatic and/or splenic artery, Measurement of coeliac trunk diameter, Distance between coeliac trunk and the superior mesenteric artery were taken. Conclusion: Knowledge of variations concerning the coeliac trunk is of extreme clinical importance in the areas of the laparoscopic surgery, and radiological procedures in the upper abdomen, and should be kept in mind by clinicians to avoid complications.

Vascular variations of liver and gallbladder: a case report / 대한해부학회지

Vascular variations in and around the porta hepatis are common. A sound knowledge of possible variations at these sites is vital for surgeons during laparoscopic cholecystectomy and surgical resection of the liver lobes. We report the case of several variations of the hepatic and cystic arteries in which, the common hepatic artery trifurcated into the gastroduodenal, right hepatic, and left hepatic arteries. The right gastric artery arose from the left hepatic artery and divided into a left and a right branch. The left branch entered the liver through the porta hepatis, while the right branch passed behind the common hepatic duct into the Calot's triangle, provided 2 branches to the gallbladder, and continued to supply the right hepatic lobe. Ligation of the right branch of the right hepatic artery in Calot's triangle during cholecystectomy could cause avascular necrosis of the liver segments it supplies.

A Case of Ruptured Left Gastric Artery Pseudoaneurysm Complicating Percutaneous Endoscopic Gastrostomy (PEG) / 대한소화기내시경학회지

Percutaneous endoscopic gastrostomy (PEG) is an effective method for delivering enteral nutrition to patients with dysphagia, cerebrovascular accidents, Parkinsonnism, dementia, and head and neck cancer. PEG is generally regarded as safe and it is associated with low risks of morbidity and mortality. The complications of the PEG are known to be mostly minor and they include wound infection, gastric leakage, bleeding, ileus, pneumoperitoneum and aspiration pneumonia. We recently experienced a ruptured pseudoaneurysm of the left gastric artery, which was occurred as a complication during PEG insertion in a 73-year-old female. To the best of our knowledge, this is the first case report in Korea about successful angiographic embolization for a ruptured pseudoaneurysm of the left gastric artery and this was associated with a PEG procedure.

The Preservation of Left Gastric Atery in Laparoscopy-Assisted Subtotal Gastrectomy with Splenectomy of Stomach Cancer

Usually in the subtotal gastrectomy, the left and the right gastric arteries, as well as the left and the right gastroepiploic arteries are ligated. Thus, to avoid a blue stomach surgeons preserve the spleen and the short gastric arteries. When a radical subtotal gastrectomy with splenectomy is performed, meticulous caution is necessary; otherwise, the subtotal gastrectomy might have to be changed to a total gastrectomy to prevent a blue stomach. We report the case of a 67-year-old woman who had distal stomach cancer with a splenic solitary mass, for which splenic meatastasis could be excluded. We planned and performed a laparoscopy-assisted radical subtotal gastrectomy with splenectomy as the diagnostic and therapeutic option. In this case, to avoid a remnant stomach infarction or total gastrectomy we saved the left gastric artery and vein with clearing perivascular soft tissue, lymphatics, and lymph nodes. Thus the radical therapeutic goal was reached, and serious complications were avoided.

Hemoperitoneum Due to Spontaneous Rupture of an Aneurysm of the Right Gastric Artery

We report a case of a 46-year-old male patient who presented with sudden abdominal pain and hypovolemic shock. The initial hemoglobin level was 11.9 g/dl, which fell to 6.9 g/dl after hydration. The emergent CT showed a large amount of hemoperitoneum and dye leakage. Emergent angiography and gell foam embolization were performed under the diagnosis of right gastric artery aneurysm rupture.

A Case of Pulmonary Sequestration Supplied with Left Gastric Artery / 결핵

The bronchopulmonary sequestration is a region of lung parenchyma that has an incomplete or no connection with the airways and is supplied by an aberrant artery arising from the aorta or one of its branches. The anatomy of supplied artery is very important during operation. We present a case of pulmonary sequestration supplied with left gastric artery. The patient was 61 years old male and had hemoptysis. The left lower lung was cystic bronchiectasis and a few air-fluid level on chest CT. Also, in aortogram, arterial supply was from left gastric artery of abdominal aorta branches. Left lower lobectomy and abnormal arterial ligation was done.

A Case of Hemoperitoneum due to Splanchnic Artery (Left gastric artery) Aneurysmal Rupture / 대한내과학회지

Splanchnic artery aneurysms, previously thought to be rare, are being diagnosed with incresed frequency because of development of noninvasive imaging techniques. The pathogenesis of visceral aneurysms is varied and may be secondary to arteriosclerosis (30%), trauma (25%), inflammation (11%), gestational alteration, surgery, infection, medial necrosis, collagen vascular disease, arteritis, and congenital anomalies. Clinical manifestation of visceral artery aneurysms is vague and not specific. The diagnosis and treatment for them are difficult. Preoperative arteriography may be helpful in emergency situation to detect the aneurysm and visualize multiple aneurysms. Surgical ligation, resection and/or reconstructive surgery are first choice of treatment for them. Otherwise, transarterial embolization has also been reported for them recently. We report a case of hemoperitoneum due to left gastric artery aneurysmal rupture and a rare complication of splanchnic artery aneurysm "Double rupture". The patient was treated successfully with simple ligation of the ruptured vessel.