Gastroduodenal artery pseudoaneurysm

Case contributed by Kelvin Feng

Presentation

Acute abdominal pain. Nausea and vomiting. Jaundice. Markedly deranged liver function tests.. History of alcohol abuse.

Patient Data

Age: 45 years
Gender: Male

Bilobed enhancing focus in the head and uncinate process of the pancreas representing a gastroduodenal artery pseudoaneurysm. Non-enhancing mildly dense rind of tissue surrounding this enhancing lumen indicates thrombus. No peripancreatic collection. Moderate dilatation of the intrahepatic bile ducts and compression of the common bile duct by the pseudoaneurysm. Effacement of the confluence of the superior mesenteric vein and the portal vein.

Dystrophic calcification of the slightly atrophic pancreatic body and tail which is suggestive of chronic pancreatitis. Prominence of the pancreatic duct may be secondary to mass effect. Stranding around the pancreas, particularly at the pancreatic head, likely represents acute pancreatitis. Distended gallbladder. Suboptimal contrast opacification of the left portal vein branches may suggest a non-occlusive thrombus. Prominent upper abdominal lymph nodes.

Pre-embolization of a large, wide-necked gastroduodenal artery pseudoaneurysm.

Case Discussion

Visceral artery aneurysms are rare with an approximate incidence of 0.01-0.1%, of which gastroduodenal artery aneurysms account for about 1.5% 1,2. These can be further subdivided into true and false aneurysms 2. In this particular case, the likely etiology of the pseudoaneurysm was recurrent pancreatitis in association with alcohol abuse.

The patient was initially managed by ultrasound-guided percutaneous thrombin injection. This resulted in complete thrombosis of the pseudoaneurysm lumen. Unfortunately, the pseudoaneurysm recanalized and the patient proceeded to undergo coil embolization which was complicated by hepatic artery dissection distal to the origin of the pseudoaneurysm. The patient subsequently underwent an open splenic artery to hepatic artery bypass graft followed by a cholecystectomy.

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