Gastroduodenal artery pseudoaneurysm - post traumatic

Case contributed by Dr Craig Hacking

Presentation

Massive haematemesis. 2 months post multitrauma.

Patient Data

Age: 30
Gender: Male

A contrast blush is seen on the arterial phase images extending from the gastroduodenal artery into a round lobulated 8 x 5.1 x 4.2 cm soft tissue density along the dorsal aspect of the pylorus which demonstrates homogeneous enhancement on the delayed images. This is most in keeping with a gastroduodenal pseudoaneurysm which has likely developed following the abdominal trauma particularly in the setting of pancreatic lacerations. The pseudoaneurysm is closely related to the pancreatic neck with effacement of the neck. Heterogeneous material in the stomach and history of massive haematemesis in keeping with rupture of the pseudoaneurysm in to the pylorus however active extravasation from the pseudo-aneurysm into the stomach is not identified.

IVC filter in situ. The IVC and common iliac veins are collapsed.

Previous laparotomy with small bowel surgery with anastomotic sutures in the ilium.

Previous right sacral alar, iliac and bilateral pubic bone fractures noted. Evidence of previous pelvic fixation.

Bilateral lower lobe atelectasis.

Conclusion

8 cm gastroduodenal pseudoaneurysm.

A truncated right gastroduodenal artery was identified and there was no active contrast extravasation or pseudo-aneurysm formation. Further interrogation of this segment of the vessel with a microcatheter showed contrast extravasation hence embolised using multiple coils. Post coiling angiogram revealed satisfactory occlusion of the truncated gastroduodenal artery without any further contrast extravasation. Further interrogation of inferior pancreaticoduodenal artery off the SMA did not reveal any back flow towards the superior pancreaticoduodenal artery or filling of any pseudo-aneurysm.

Delayed phase of the mesentery angiogram demonstrates good opacification of the portal venous system without any evidence of active contrast extravasation from the venous aspect. At the end of the procedure abdominal aortic angiogram performed which did not reveal any evidence of further extravasation of contrast or filling of an pseudo-aneurysm.

Case Discussion

Great case of a post traumatic GDA pseudoaneurysm treated with coiling.

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Case information

rID: 41274
Case created: 24th Nov 2015
Last edited: 6th Sep 2016
Tag: trauma
Inclusion in quiz mode: Included

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