Coil embolization of a ruptured gastroduodenal artery pseudoaneurysm presenting with hemosuccus pancreaticus

Abstract

Hemosuccus pancreaticus is a rare form of upper gastrointestinal bleeding that accounts for roughly 1 in 1500 cases. It is characterized by hemorrhage from the ampulla of Vater secondary to rupture of a peripancreatic pseudoaneurysm or visceral artery pseudoaneurysm. Among the visceral artery pseudoaneurysms, gastroduodenal artery pseudoaneurysms are among the rarest. In this case report, we describe a successful coil embolization of a large ruptured gastroduodenal pseudoaneurysm in a patient with massive gastrointestinal bleeding.

Keywords: Hemosuccus pancreaticus; Visceral artery pseudoaneurysms; coil embolization.

Fig 1

Intraoperative angiography with catheter placed in the gastroduodenal artery (GDA) pseudoaneurysm (A), revealing contrast material in the GDA pseudoaneurysm (B) and noted to be spilling into the pancreas (C) and extravasating into the duodenum (D) through the ampulla of Vater (hemosuccus pancreaticus).

Fig 2

A, Selective common hepatic artery angiography reveals gastroduodenal artery (GDA) pseudoaneurysm. B, The postembolization angiogram shows exclusion of the pseudoaneurysm sac and flush occlusion of the GDA.

Fig 3

Selective superior mesenteric artery angiography reveals successful exclusion of gastroduodenal artery (GDA) pseudoaneurysm as evidenced by lack of contrast material opacification within pseudoaneurysm sac.

Fig 4

Illustration depicting the gastroduodenal artery (GDA) pseudoaneurysm resulting in a pancreatic duct fistula with hemorrhage into the duodenum (hemosuccus pancreaticus; left) and successful coil embolization (right).