Gastroduodenal Artery Pseudoaneurysm Rupture Post-Billroth II Surgery: Case Report

Abstract

Visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPAs) are defined as more than a 1.5 fold increase in the normal diameter of the celiac, superior, or inferior mesenteric arteries and their branches. They represent a rare finding with an incidence ranging between 0.1% to 0.2%. Depending on the mechanism of formation, aneurysms can be divided into true aneurysms or pseudoaneurysms. True aneurysms involve all layers of the wall, which are usually thinned but remain intact and commonly result from vessel wall abnormalities. However, pseudoaneurysms occur after vascular injuries or nearby inflammatory process causing a tear in the vessel wall. Pancreatitis is the most common cause of pseudoaneurysm. Nevertheless, other conditions, such as autoimmune disorders, vascular interventions, laparoscopic cholecystectomy, and even hepatic transplantation, have been reported to increase the risk of pseudoaneurysm formation. Herein, we are reporting a case of a gastroduodenal artery pseudoaneurysm rupture in a patient with altered anatomy secondary to Billroth II surgery.

Keywords: aneurysm; gastroduodenal artery; gastrointestinal bleed; pseudoaneurysm.

Figure 1. Contrast-enhanced computed tomography (axial view) showing contrast material extravasation from gastroduodenal artery pseudoaneurysm

Figure 2. Computed tomography (CT) of the abdomen (axial view) showing blood in the small intestine

Figure 3. Computed tomography (CT) of the abdomen (axial view) showing blood in the small intestine