Year 2023 / Volume 115 / Number 9
Letter
Gastroduodenal artery pseudoaneurysm presenting with hyperamylasemia

535-536

DOI: 10.17235/reed.2022.9407/2022

Cristiana Sequeira, Inês Santos, Sara Lopes, Vitor Carvalheiro, João Mangualde, Ana Paula Oliveira,

Abstract
We present the case of a 75-year-old male admitted due to severe epigastric pain. His medical history was remarkable for chronic alcohol abuse, diabetes mellitus type 2, arterial hypertension, dyslipidemia. At admission he was hemodynamically stable. The initial workup showed elevated amylase, and the abdominal ultrasound excluded gallstone disease, so the diagnosis of acute pancreatitis was assumed. Despite appropriate fluid therapy, the patient developed hemodynamic instability. No signs of GIB were detected. An urgent laboratory workup revealed a new onset anemia and liver tests, including hyperbilirrubinemia. He underwent an urgent abdominal computed tomography with contrast, which showed a bleeding gastroduodenal artery (pseudoaneurysm and a hematoma adjacent to the second part of the duodenum. The patient underwent coil embolization achieving hemostasis without complications. GAD (pseudo)aneurysm is rare, accounting for 1.5% of all visceral artery aneurysms. Our patient presented with elevated pancreatic and liver enzymes, a more unique and challenging presentation since another more common differential diagnosis should be considered. The aneurysm can cause extrinsic common bile duct and main pancreatic duct pressure, which could explain the raised liver tests. Gastroenterologists should be aware of this rare and life-threatening entity, especially among patients presenting with common findings such as elevated amylase, jaundice, or altered liver tests. Hemodynamic instability is the main clue unmasking this diagnosis.
Share Button
New comment
Comments
No comments for this article
References
1. Habib N, Hassan S, Abdou R, Torbey E, Alkaied H, Maniatis T, Azab B, Chalhoub M, Harris K. Gastroduodenal artery aneurysm, diagnosis, clinical presentation and management: a concise review. Ann Surg Innov Res. 2013 Apr 16;7(1):4. doi: 10.1186/1750-1164-7-4. PMID: 23587203; PMCID: PMC3637616.
2. Macedo C, Gravito-Soares E, Gravito-Soares M. Pseudoaneurysm of the gastroduodenal artery with arterio-duodenal fistulization secondary to acute pancreatitis: an unusual endoscopic diagnosis. Rev Esp Enferm Dig. 2021 Jan;113(1):72-73. doi: 10.17235/reed.2020.7070/2020. PMID: 33207898.
3. Bergert H, Hinterseher I, Kersting S, Leonhardt J, Bloomenthal A, Saeger HD. Management and outcome of hemorrhage due to arterial pseudoaneurysms in pancreatitis. Surgery. 2005 Mar;137(3):323-8. doi: 10.1016/j.surg.2004.10.009. PMID: 15746787
4. Bauer JR, Ray CE. Transcatheter Arterial Embolization in the Trauma Patient: A Review. Semin intervent Radiol. 2004 Mar;21(1):11–22.
Related articles

Editorial

Etiological diagnosis of recurrent acute pancreatitis

DOI: 10.17235/reed.2024.10404/2024

Letter

Spontaneous cystogastric fistula: an accidental discovery

DOI: 10.17235/reed.2023.9912/2023

Digestive Diseases Image

Spontaneous duodenal wall hematoma

DOI: 10.17235/reed.2023.9793/2023

Letter

Acute pancreatitis due to osteosarcoma metastasis

DOI: 10.17235/reed.2023.9729/2023

Letter

Anemia can predict organ failure in acute pancreatitis

DOI: 10.17235/reed.2023.9700/2023

Letter

Colon necrosis in acute severe pancreatitis

DOI: 10.17235/reed.2022.9263/2022

Letter

Disconnected pancreatic duct syndrome. Endoscopic approach

DOI: 10.17235/reed.2022.9261/2022

Letter

The enigmatic triad, a clinical challenge

DOI: 10.17235/reed.2022.9212/2022

Letter

Spontaneous drainage of a pancreatic pseudocyst into the stomach

DOI: 10.17235/reed.2022.8999/2022

Editorial

Acute pancreatitis: an opportunity for gastroenterology hospitalists?

DOI: 10.17235/reed.2022.8573/2022

Digestive Diseases Image

Endoscopic necrosectomy – when the gastroenterologist faces his greatest nightmare.

DOI: 10.17235/reed.2021.8403/2021

Digestive Diseases Image

Wunderlich syndrome secondary to severe acute pancreatitis

DOI: 10.17235/reed.2021.8184/2021

Digestive Diseases Image

Emphysematous pancreatitis: a rare entity with characteristic radiological findings

DOI: 10.17235/reed.2021.8093/2021

Letter

Acute pancreatitis related to SARS-CoV-2 infection. Disclaimer

DOI: 10.17235/reed.2021.7853/2021

Letter

Pancreatic injury and acute pancreatitis in COVID-19 patients

DOI: 10.17235/reed.2021.7807/2021

Letter

Pancreatic injury in COVID-19: pathogenesis and challenges

DOI: 10.17235/reed.2020.7541/2020

Letter

SARS-CoV-2 and acute pancreatitis: a new etiological agent?

DOI: 10.17235/reed.2020.7481/2020

Letter

Management of hepatic artery aneurysms

DOI: 10.17235/reed.2020.7219/2020

Letter

Bortezomib-induced acute pancreatitis, an uncommon adverse event

DOI: 10.17235/reed.2020.7120/2020

Editorial

Guessing the future of endoscopic drainage of walled-off necrosis

DOI: 10.17235/reed.2020.7252/2020

Letter

Problems with a prophylactic non-expulsive pancreatic stent

DOI: 10.17235/reed.2020.7001/2020

Letter

Viral infection and pediatric pancreatitis

DOI: 10.17235/reed.2020.6933/2020

Digestive Diseases Image

Groove pancreatitis: a rare cause of severe gastric dilation

DOI: 10.17235/reed.2020.6765/2019

Letter

Acute pancreatitis associated with levofloxacin

DOI: 10.17235/reed.2020.6652/2019

Digestive Diseases Image

Endoscopic therapy in disconnected duct syndrome: re-connecting the duct

DOI: 10.17235/reed.2020.6650/2019

Digestive Diseases Image

Colon perforation due to fistulization of a pancreatic pseudocyst

DOI: 10.17235/reed.2018.5884/2018

Digestive Diseases Image

A rare case of acute obstructive suppurative pancreatic ductitis associated with ERCP

DOI: 10.17235/reed.2018.5756/2018

Letter

Biliary bleeding due to a hepatic artery pseudoaneurysm rupture

DOI: 10.17235/reed.2018.5661/2018

Editorial

Pancreatic stents in ERCP. Where are we?

DOI: 10.17235/reed.2018.5670/2018

Letter to the Editor

Tender red subcutaneous nodules in an adult female: a challenging diagnosis

DOI: 10.17235/reed.2018.5472/2018

Letter to the Editor

A patient with Castleman’s disease mimicking acute pancreatitis

DOI: 10.17235/reed.2017.5120/2017

Digestive Diseases Image

Hemobilia due to a cystic artery pseudoaneurysm on ultrasound

DOI: 10.17235/reed.2017.4936/2017

Digestive Diseases Image

Hemosuccus pancreaticus secondary to pseudoaneurysm of the splenic artery

DOI: 10.17235/reed.2017.4893/2017

Letter to the Editor

Abdominal compartment syndrome secondary to acute necrotizing pancreatitis

DOI: 10.17235/reed.2017.4810/2016

Letter to the Editor

Genetics in idiopathic pancreatitis and acute recurrent pancreatitis

DOI: 10.17235/reed.2017.4632/2016

Letter to the Editor

Hemobilia related to cystic artery pseudoaneurysm as a cause of acute pancreatitis

DOI: 10.17235/reed.2017.4532/2016

Letter to the Editor

Xanthogranulomatous pancreatitis: a lesion that mimics pancreatic cancer

DOI: 10.17235/reed.2017.4496/2016

Letter to the Editor

Intramural gastric hematoma in the context of an acute pancreatitis

DOI: 10.17235/reed.2017.4494/2016

Case Report

Case of drug-induced acute pancreatitis produced by horsetail infusions

DOI: 10.17235/reed.2017.4157/2015

Case Report

Pseudoaneurysm associated with complicated pancreatic pseudocysts

DOI: 10.17235/reed.2016.3855/2015

Case Report

Acute hemorrhagic necrotizing pancreatitis in falciparum malaria

DOI: 10.17235/reed.2015.3768/2015

Citation tools
Sequeira C, Santos I, Lopes S, Carvalheiro V, Mangualde J, Oliveira A, et all. Gastroduodenal artery pseudoaneurysm presenting with hyperamylasemia . 9407/2022


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1019 visits.
This article has been downloaded 42 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 06/12/2022

Accepted: 14/12/2022

Online First: 20/12/2022

Published: 06/09/2023

Article Online First time: 14 days

Article editing time: 274 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology