Gastro-Duodenal Artery Aneurysm Rupture – Case Report

Abstract

Background

The definition of an aneurysm is a dilation of an artery more than 1.5 to 2 times its normal diameter. Visceral (or splanchnic) artery aneurysms include those concerning the celiac truncus, superior mesenteric artery, inferior mesenteric artery, and their branches. This classification does not include aortic and renal artery aneurysms. It is a rare, but clinically significant pathology because of the high mortality risk. Despite this rarity, cases have been accumulated and this pathology is better understood. Novel techniques for the management of aneurysms have been developed with the advent of interventional radiology. However, our case concerns the emergent surgical repair of a ruptured aneurysm, rather than the elective repair.

Case presentation

The 61-year-old female patient complains of diffuse, intermittent abdominal pain lasting for almost one week. On the last day the patient suffers from excruciating abdominal pain and is brought to the emergency department. Objective evaluation shows pallor, diaphoresis, low blood pressure, tachycardia and abdominal guarding in all quadrants. An abdominal ultrasound spots the presence of free fluid in all recesses. A diagnostic peritoneal needle aspiration shows pure blood. AB0 and Rhesus blood type is identified and the patient is prepared for the operating theatre. Following a laparotomy, peritoneal lavage, a rupture of gastro-duodenal aneurysm is identified and the artery is ligated in its origin. The patient tolerated the procedure well and was discharged in good health.

Discussion

Rare case reports in literature have reported Gastro-duodenal artery aneurysms. Because of this rarity in incidence there is no clear protocol on how to diagnose and manage it. Possible risk factors and associated conditions include: chronic pancreatitis, liver cirrhosis, vascular abnormalities as fibromuscular dysplasia and polyarteritis nodosa. Other events and diseases such as trauma, septic emboli, hypertension and atherosclerosis are also mentioned. The main symptoms of visceral artery aneurysms, with or without rupture are abdominal pain, hypotension, gastric emptying delay and other non-specific manifestations such as vomiting, diarrhoea, jaundice, upper gastro-intestinal tract haemorrhage (which occurs in about 50% of the cases with gastro-duodenal artery aneurysms) and retro and intra-peritoneal bleeding.

Conclusion

The rupture of gastro-duodenal artery is a serious fatal presentation of a rare condition. It requires high alertness and decisive action, as warning signs and symptoms may be dull or absent. Quick diagnosis before rupture can change the course of this disease and prevent lethal complications. As this disorder is so uncommon, there are no specific screening or follow-up recommendations. Treatment and diagnostic options should be decided on a case basis.

Keywords: General Surgery, Visceral Artery Aneurysm, VAA, Splanchnic Aneurysm, Aneurysm Rupture.

DOI: 10.7176/JEP/14-8-02

Publication date:March 31^st 2023