A 30-year-old female with a history of acute biliary pancreatitis two months ago,
presented with a four-week history of recurrent vomiting, occurring one to two
hours after meals. The patientunderwent an endoscopy, showing a 3 cm mass arising
from the posterior wall of the duodenal bulb impinging the pyloric opening (Fig. 1A), with overlying normal mucosa. In view of a suspected subepithelial lesion, an
endoscopic ultrasound was performed, showing a 3.2 × 2.6 cm aneurysm (Long arrow,
Fig. 1B) arising from the gastroduodenal artery (GDA) (Short arrow, Fig. 1B). The patient underwent a conventional angiography showing an aneurysm arising from
the proximal part of GDA with a narrow neck (Fig. 1C). Coil embolization was performed, leading to aneurysmal obliteration (Fig. 1D) with symptomatic improvement over the next three days. GDA aneurysm associated
with acute pancreatitis is primarily due to periarterial inflammation. The usual presentations
are GI bleeding, abdominal pain, or jaundice. However, GDA aneurysms presenting as
gastric outlet obstruction are rare, with only one prior reported case [
[1]
]. Hence, visceral artery aneurysm should be suspected as an etiology apart from pancreatic
fluid collections in a patient with acute pancreatitis presenting with gastric outlet
obstruction.
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Reference
- Gastric outlet obstruction caused by a giant gastroduodenal artery aneurysm: a case report.Eur J Gastroenterol Hepatol. 2001; 13: 59-61
Article info
Publication history
Published online: June 13, 2022
Accepted:
May 20,
2022
Received:
May 18,
2022
Identification
Copyright
© 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
