Awa Drame, MD, MPH
University of South Florida Morsani College of Medicine, Tampa, FL
Introduction: Gastroduodenal artery (GDA) aneurysms are rare, accounting for about 1.5% of all visceral arterial aneurysms. Two main entities of aneurysms exist: pseudoaneurysms occuring secondary to chronic pancreatitis and true aneurysms, less common and associated with artherosclerotic risk factors. The most serious complication of aneurysms is rupture with mortality rate of up to 70%. Early diagnosis is paramount to patient’s survival. GDAs may rupture into the superior mesenteric vein causing bleeding esophageal varices or into the peritoneum causing hemorrhagic shock or into the gastro-intestinal tract (GIT) causing hematemesis, melena or hemobilia.
We herein report the case of a GDA rupture into the gastro-intestinal tract (GIT) which presented with sudden onset of abdominal pain and hypotension. Melena and hematochezia, typical clinical presentation associated with GIT bleed were absent secondary to severe opioid-induced fecal impaction. Despite this, high suspicion and early angiographic intervention helped in saving the patient’s life.
Case Description/Methods: A 72-year-old male with a remote history of ulcerative colitis and active metastatic stage IV prostate adenocarcinoma to the brain, spine and bladder presented to the hospital with abdominal pain, hematuria and hypotension. He was admitted a week prior with similar complaints (right-sided flank pain and hematuria). In the ED, BP 94/46 with a leukocytosis of 11 and hemoglobin of 6.8. Foley catheter was placed with return of 400 cc of frank blood. He received 2 units of blood and was admitted to the ICU. Physical examination on admission was significant for abdominal distention, tenderness and hypoactive bowel sounds. He rapidly decompensated despite aggressive fluid resuscitation and vasopressors. He went into PEA arrest and ROSC was obtained after multiple ACLS rounds. CT A/P showed contrast extravasation at the posterior wall of the gastric body. Our GI service performed emergent EGD. There was a single deep, cratered and punched-out ulcer measuring 4 cm that was spurting blood. 3 clips were applied to control the bleeding. The following day, IR successfully embolized the GDA. Blood pressure stabilized and the patient was weaned off the ventilator and extubated. He was discharged hemodynamically stable.
Discussion: Giving the rarity of GDA rupture, there are no clear screening or follow-up guidelines. Decisions about diagnostic and therapeutic procedures should be prompt and made on an individual basis.
Citation: Awa Drame, MD, MPH. P1353 - THE SUCCESSFUL TREATMENT OF A GASTRODUODENAL ARTERY RUPTURE WITH EXTRAVASATION INTO THE DUODENAL LUMEN. Program No. P1353. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.