[Aneurysm of the gastroduodenal artery ruptured into the peritoneum. Treatment by embolization]. / Anévrysme de l'artère gastro-duodénale rompu en péritoine libre. Traitement par embolisation.

Aneurysms rarely occur in the gastroduodenal artery. We encountered such an aneurysm which bled into the peritoneum leading to a difficult diagnostic situation. A 58-year-old man was hospitalized for acute abdominal pain. Past history included alcohol intake (wine, 3/4 litre per day) and moderate increase in serum gamma-glutamyl transferase levels (100 IU/L). At admission there was abdominal contracture, vomiting and shock (blood pressure 70 mmHg). Based on the clinical picture and laboratory tests the diagnosis of acute pancreatitis was entertained, but after the haemodynamic situation was reestablished by intravenous fluids, echography and computed tomography of the abdomen failed to give confirmation. An effusion however was seen in the peritoneum together with a large mass in the head of the pancreas compatible with a haematoma. Arteriography rapidly demonstrated an aneurysm of the gastroduodenal artery. Embolization was preferred over surgery due to the precarious haemodynamic situation. Outcome was quite favourable and no complications have been observed with a follow-up of 6 months. Reports of true aneurysms of the gastroduodenal artery are rare but clinical manifestations are usually latent or absent. Reported complications include massive digestive haemorrhage and rarely jaundice, haemobilia or wirsungorrhagia due to compression. Excepting recognized trauma, few aetiological factors have been determined. Fragile arterial walls due to atheroma, isolated dysplasia or connective tissue disease appear to be damaged by successive systolic distension leading to rupture of certain elements of the arterial wall and finally aneurysm. Embolization carries less risk than surgical repair but must be indicated only after precise characterization including localization, size and local involvement.

[Gastric necrosis caused by acute gastric dilatation. Total gastrectomy. Recovery]. / Nécrose gastrique par dilatation gastrique aiguë. Gastrectomie totale. Guérison.

Acute gastric dilatation, a rare affection, has multiple origins. An episode of bulimia following a fast in relation to an anorexia nervosa is one of the classical causes of its onset. Diagnosis is by radiology and should be made urgently before instituting medical treatment combining aspiration and effective intensive care measures. Recovery is the general rule. The formation of an infarct and gastric perforation are complications of delayed diagnosis and are of extreme gravity, leading to a fatal outcome in more than 80% of cases. In the case reported, recovery was obtained by emergency total gastrectomy for global gastric infarction. Perioperative fibroscopy is the essential key to the choice between temporary esophageal exclusion or immediate re-establishment of digestive continuity.