Presentation
Abdominal pain, constipation, single episode of vomiting.
Patient Data
Hypodense process with ill-defined borders measuring approximately 3.2 x 2.2 x 2.9 cm with a density of 50±5 HU fills the pancreaticoduodenal groove. The process exerts mass effect on both the duodenum and the head of the pancreas and contains small gas bubbles. Mild fat stranding surrounding the second duodenal segment.
The patient underwent ultrasonographic investigation of his partly thickened gallbladder.
Partially distended gallbladder not containing gallstones. Gallbladder wall mildly thickened with numerous cholesterol crystals (comet tail sign), some with calcification (twinkle artifact).
Gastroduodenoscopy showed massive bleeding from a duodenal ulcer.
Angiography was then performed for localization and embolization of the bleeding vessel.
Right transfemoral access via 5F introducer sheath, hemostasis with Angioseal 6F.
Case Discussion
Since the patient initially presented with vague abdominal complaints and an initial KUB (not shown) was interpreted as normal, he underwent abdominal CT scanning. The CT findings, highly suspicious for a bleeding duodenal ulcer, were validated on gastroduodenoscopy. DSA was performed where, even though there was no demonstration of active bleeding, the gastroduodenal artery (GDA) was correctly surmised to be the culprit artery since it supplies the proximal duodenum.
The gallbladder fundal wall thickening turned out to be adenomyomatosis.