This occurs regardless of the location of the stenosis [13]. Gastroduodenal artery aneurysm is a rare vascular lesion, asymptomatic in the majority of cases. Please enable it to take advantage of the complete set of features! Gastroduodenal artery (GDA) aneurysms are rare but a potentially fatal condition if rupture occurs. Epub 1994/08/01 10.1016/0720-048X(94)90343-3, Ochi T, Suzuki T, Yoshioka N, Ogawa Y, Inagaki T, Suzuki S: [A case of aneurysm of the gastroduodenal artery diagnosed by endoscopic ultrasonography--review of literatures in Japan]. J Vasc Bras. More inferiorly it bifurcates into 2 arteries at the upper border of the pancreas: Ann Surg Innov Res 7, 4 (2013). World J Gastrointest Surg. Below are the links to the authors’ original submitted files for images. Acta Radiol (Stockholm, Sweden: 1987) 2004,45(7):702–708. The gastroduodenal artery is a terminal branch of the common hepatic artery along with the proper hepatic artery. Nihon Shokakibyo Gakkai zasshi Jpn J Gastro-enterology 1992,89(2):522–527. The gold standard diagnostic test is visceral angiography [28] and it serves both diagnostic and therapeutic purposes by delineating the arterial anatomy and allowing therapeutic intervention [28, 29]. Although most visceral artery aneurysms and visceral artery pseudoaneurysms occur in the splenic artery or hepatic artery, they can rarely occur in the gastroduodenal artery. Privacy Bethesda, MD 20894, Copyright volume 7, Article number: 4 (2013) J Am Coll Surg 2009,208(2):316. Once a GDA aneurysm ruptures, the patient faces a life threatening condition that could rapidly lead to death in 40% of cases [18]. Ann Vasc Surg 1990,4(6):540–545. Epub 1999/11/05 10.1016/S1072-7515(99)00168-4, Moore E, Matthews MR, Minion DJ, Quick R, Schwarcz TH, Loh FK: Surgical management of peripancreatic arterial aneurysms. Google Scholar, Bassaly I, Schwartz IR, Pinchuck A, Lerner R: Aneurysm of the gastroduodenal artery presenting as common duct obstruction with jaundice. ... right hepatic artery (arrow) (normal variation seen in approximately 11% of cases) and inferior pancreatoduodenal artery aneurysm (arrowhead). Epub 1998/05/20 10.1007/s100169900155, Gouny P, Fukui S, Aymard A, Decaix B, Mory H, Merland JJ: Aneurysm of the gastroduodenal artery associated with stenosis of the superior mesenteric artery. 2020 Jul 8;4(5):923-928. doi: 10.1002/jgh3.12365. Vasc Endovascular Surg 2008,42(5):497–499. ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Epub 1973/05/01, Bohl JL, Dossett LA, Grau AM: Gastroduodenal artery pseudoaneurysm associated with hemosuccus pancreaticus and obstructive jaundice. Thus, true aneurysms in the pancreaticoduodeal and gastroduodenal arteries are extremely rare and represent only 3.5% of all VAA [5]. 2017 May;41:32-40. doi: 10.1016/j.avsg.2016.09.018. PubMed  10.1186/1750-1164-7-4; Cordova AC, Sumpio BE: Visceral artery aneurysms and pseudoaneurysms—should they all be managed by endovascular techniques?. statement and Surgery 2005,137(3):323–328. Epub 2017 Feb 24. The authors declare that they have no competing interests. J Vasc Surg Offic Publ Soc Vasc Surg Int Soc Cardiovasc Surg North Am Chapter 2005,42(1):153–158. Abstract We report a case of a 51-year-old patient with chronic pancreatitis and a giant gastroduodenal artery pseudoaneurysm. In gastroduodenal artery, the disesase develops in less than 1.5%, although the risk of rupture reaches 70%. Int Med (Tokyo, Japan) 1998,37(11):930–933. Epub 1986/11/01, Pilleul F, Beuf O: Diagnosis of splanchnic artery aneurysms and pseudoaneurysms, with special reference to contrast enhanced 3D magnetic resonance angiography: a review. 2013, 6:687-93. RadioGraphics Rev Publ Radiol Soc North Am Inc 2004,24(2):481–496. Privacy, Help Epub 1996/09/01 10.1007/BF02000601, CAS  Google Scholar, Chong WW, Tan SG, Htoo MM: Endovascular treatment of gastroduodenal artery aneurysm. Therefore, it is of utmost importance to diagnose and treat GDA aneurysms before a fatal complication occurs. Epub 1993/07/01 10.1016/S1051-0443(93)71920-X, Burke JW, Erickson SJ, Kellum CD, Tegtmeyer CJ, Williamson BR, Hansen MF: Pseudoaneurysms complicating pancreatitis: detection by CT. Radiology 1986,161(2):447. CT scan has the advantage of being non invasive and localizing the aneurysm with its relations to surrounding structures (Figure 1). In conclusion, physicians might only encounter GDA aneurysms as an incidental finding on CT scans. Abstract Aneurysm of gastroduodenal artery (GDA) is rare. Prevention and treatment information (HHS). Ann Vasc Surg 2011,25(7):923–935. This article is published under license to BioMed Central Ltd. KH contributed to developing the review concept. Aneurysms of pancreaticoduodenal arcade: Clinical profile and endovascular strategies. Epub 2009/03/13 10.1007/s00423-009-0482-z, Germanos S, Soonawalla Z, Stratopoulos C, Friend PJ: Pseudoaneurysm of the gastroduodenal artery in chronic pancreatitis. Visceral artery aneurysms (VAA) are infrequent conditions characterized by a wide range of clinical presentations and various clinical outcomes. Most reported cases are due to pancreatitis and atherosclerosis; however, those following pancreatic trauma have not been reported. and the pancreatico-duodenal arteries (15%) because of their close associa-tion vi/ith the head of the pancreas (10. Clinical suspicion and advanced imaging tools should be employed in a timely fashion to make a diagnosis before this ominous event. See this image and copyright information in PMC. As for pseudoaneurysms, inflammation with the most common cause being pancreatitis, results in vascular wall destruction that is mediated by pancreatic proteolytic enzymes leading to pseudoaneurysm formation [17]. J Vasc Intervent Radiol JVIR 2007,18(1 Pt 1):117–120. The estimated incidence varies from one in 10,000 to one in 20,000 individuals; fewer than 200 cases have been reported in the literature, with many older publications describing syphilis-related aneurysms in men ( 42 ). Cookies policy. Keywords: They represent about 1.5% of all visceral artery (VAA) aneurysms and are divided into true and pseudoaneurysms depending on the etiologic factors underlying their development. Epub 1999/05/06, Eckhauser FE, Stanley JC, Zelenock GB, Borlaza GS, Freier DT, Lindenauer SM: Gastroduodenal and pancreaticoduodenal artery aneurysms: a complication of pancreatitis causing spontaneous gastrointestinal hemorrhage. Epub 2021 Mar 23. Cite this article. Aneurysms of the gastroduodenal artery are rare. Epub 2007/02/14, Takahashi T, Shimada K, Kobayashi N, Kakita A: Migration of steel-wire coils into the stomach after transcatheter arterial embolization for a bleeding splenic artery pseudoaneurysm: report of a case. Splanchnic aneurysms are rare conditions, with localization at the level of the gastroduodenal artery being encountered in only 1.5 % of the cases. These two circumstances can be distinguished by the morphology of the collaterals that develop. Epub 2008/02/05, Morita Y, Kawamura N, Saito H, Shinohara M, Irie G, Okushiba S: [Diagnosis and embolotherapy of aneurysm of the gastroduodenal artery]. Clin Gastroenterology Hepatol Offic Clin Pract J Am Gastroenterological Assoc 2006,4(10):xxviii. 1 , 2 discussion 83. Eur J Radiol 1994,18(3):235–237. 8600 Rockville Pike Zaafouri H, Hasnaoui A, Essghaeir S, Haddad D, Sabbah M, Bouhafa A, Kharrat J, Ben Maamer A. BMC Surg. Epub 1995/08/01, Harris K, Chalhoub M, Koirala A: Gastroduodenal artery aneurysm rupture in hospitalized patients: An overlooked diagnosis. For example, vascular supply to the stomach comes from the both the GDA and the Superior Mesenteric Artery (SMA). Prior to the era of sophisticated imaging modalities the majority of cases of GDA aneurysms were undiagnosed until rupture occurred. Epub 2000/09/27 10.1016/S0002-9610(00)00380-9, Kasirajan K, Greenberg RK, Clair D, Ouriel K: Endovascular management of visceral artery aneurysm. Epub 2007/07/20 10.1007/s11605-007-0231-y, Article  Gastroduodenal artery aneurysm, diagnosis, clinical presentation and management: a concise review. Terms and Conditions, HA, TM, MC, and BA participated in research and data gathering. Atherosclerosis and pancreatitis are the two most common risk factors. Sharma S, Prasad R, Gupta A, Dwivedi P, Mohindra S, Yadav RR. Currently with the various imaging studies available, an increasingly larger number of cases are being incidentally detected in asymptomatic patients. We report 2 patients with gastroduodenal artery aneurysms, the first being an idiopathic true aneurysm and the next, a pseudoaneurysm resulting from pancreatitis. Katsumori T, Yamane T, Yokoyama Y Nihon Cho-onpa Igakukaishi (JSUM Proceedings). Google Scholar, Fodor M, Fodor L, Ciuce C: Gastroduodenal artery pseudoaneurysm ruptured in the common bile duct. A truncated right gastroduodenal artery was identified and there was no active contrast extravasation or pseudo-aneurysm formation. Ascending Cholangitis secondary to migrated embolization coil of gastroduodenal artery pseudo-aneurysm a case report. Epub 1994/04/09. In a review of the English literature over a 25 year period from 1970 to 1995, pancreatitis was found to be the most common associated condition with gastroduodenal artery aneurysm accounting for 47% of all cases followed by ethanol abuse (25%), peptic ulcer disease (17%) and cholecystectomy (3%) [5, 7, 8]. Accessibility Common causes include blunt trauma, pancreatitis, infection, autoimmune disorders, vascular intervention and surgery. Pancreaticoduodenal and Gastroduodenal Artery Aneurysms Associated with Celiac Artery Occlusive Disease. Its main complication is rupture, which is not uncommon and carries high risk of mortality. 2020 Apr 29;7(4):e00347. The diagnosis requires a high level of suspicion with specific attention to warning signs. They represent about 1.5% of all visceral artery (VAA) aneurysms and are divided into true and pseudoaneurysms depending on the etiologic factors underlying their development. This site needs JavaScript to work properly. Aneurysm of the gastroduodenal artery is a rare but well recognized complication of acute and chronic pancreatitis. A case is reported of massive, life-threatening hemorrhage in a patient with a gastroduodenal artery aneurysm. Vasc Endovascular Surg 2007,41(6):568–571. Kassem Harris. J Gastrointest Surg Offic J Soc Surg Alimentary Tract 2007,11(12):1752–1754. Avicenna J Med. In contrary, arteriosclerotic collaterals are more abundant, dilated and tortuous and hence more prone to aneursymal formation within the vessel’s wall. CT:…, Celiac angiography showing: ( A ) GDA aneurysm (pre embolization), ( B )…, National Library of Medicine Article  They have been reported in almost all the visceral arteries [5] but are most commonly seen in the splenic artery (46%), followed by the renal artery (22%), the hepatic artery (16.2%) and the pancreaticoduodenal artery (1.3%) [6]. Endovascular options include embolization of the aneurysms or stent graft deployment [41, 42] (Figure 3). Epub 1990/11/01 10.1016/S0890-5096(06)60835-2, Vogler C, Faiss J, Krause FJ, Schwamborn G: [Aneurysm of the gastroduodenal artery with aplasia of the celiac trunk]. J Endovasc Ther Offic J Inter Soc Endovasc Specialists 2001,8(2):150–155. Methods: True pancreaticoduodenal artery (PDA) and gastroduodenal artery (GDA) aneurysms associated with CA stenoses or occlusions reported from 1970 to 2010 in the English literature and similar cases treated at the University of Michigan were reviewed. However, adequate collateral flow should be documented with preoperative imaging if permitted. The gastroduodenal artery most commonly arises from either the left hepatic artery or the right hepatic artery instead. Epub 2008/08/02, Carmeci C, McClenathan J: Visceral artery aneurysms as seen in a community hospital. Atherosclerosis and pancreatitis are the two most common risk factors. Even though this less aggressive option plays an important role in high risk surgical candidates, it has its potential complications such as visceral ischemia resulting in sacrifice of the involved visceral vessel, end-organ thrombosis, and late-term vessel recanalization. Surg Today 2004,34(4):360–362. The endovascular management of a 3.5-cm gastroduodenal artery aneurysm presenting with gastritis and recurrent pancreatitis. eCollection 2020 Oct. Chang D, Patel P, Persky S, Ng J, Kaell A. ACG Case Rep J. Ann Vasc Surg 1994,8(3):281–284. Abdominal pain is the second most common symptom and occurs in 46% of cases. Its main com-plication is rupture, which is not uncommon and carries high risk of mortality. After reviewing the literature extending from1956 to 2011, 74 cases describing GDA aneurysms were collected from the Japanese and English literature. Other reported causes include congenital abnormalities (such as Marfan syndrome and Ehlers- Danlos syndrome [9]), liver cirrhosis [10], other vascular abnormalities such as fibro-muscular dysplasia, polyarteritis nodosa and predisposing events such trauma and septic emboli [11]. It passes inferiorly behind the first part of the duodenum to the left of the common bile duct where it gives off the supraduodenal artery. Surg Today 2001,31(5):458–462. Ann Vasc Surg 1996,10(5):506–515. It appears to be secondary to the proteolytic action of activated pancreatic enzymes on the arterial wall. Gastroduodenal artery aneurysms are rare. Among visceral arteries false aneurysms most commolny occur in hepatic arteries and their branches. In contrast, surgical interventions have their own share of complications such as paralytic ileus, wound infection, massive bleeding, or acute pancreatitis [41]. Making the diagnosis can be complex and often requires the use of Computed Tomography and angiography. 2017 Jul-Sep;7(3):130-132. doi: 10.4103/ajm.AJM_3_17. Habib N, Hassan S, Abdou R, et al. It may also arise from the common hepatic artery of the coeliac trunk in a trifork arrangement with the two other arteries, but there are numerous variations of the origin. Ann Vasc Surg 2004,18(6):695–703. The highest mortality rate comes from rupture into the duodenum approaching 21% [8, 19, 20]. The later adds the advantage of being a therapeutic option to prevent or stop bleeding. Common causes include blunt trauma, pancreatitis, infection, autoimmune disorders, vascular intervention and surgery. Case Report: We describe a case of gastroduodenal artery pseudoaneurysm manifesting as obstructive jaundice and pancreatitis because of extrahepatic compression of the common bile duct and pancreatic duct by mass effect. Gastroduodenal artery aneurysm, diagnosis, clinical presentation and management: a concise review Nicholas Habib, Samer Hassan, Rafik Abdou, Estelle Torbey, Homam Alkaied, Theodore Maniatis, Basem Azab, Michel Chalhoub and Kassem Harris* Abstract Gastroduodenal artery (GDA) aneurysms are rare but a potentially fatal condition if rupture occurs. Manage cookies/Do not sell my data we use in the preference centre. This could lead to gastric outlet obstruction [22] and other nonspecific symptoms such as vomiting, diarrhea and jaundice secondary to compressive hematoma or external pressure by the aneurysm [19, 25, 26]. Other diagnostic studies are available including Pulse Doppler US, color Doppler US, endoscopic ultrasound and magnetic resonance imaging [33–35] but are less frequently used. A gastrointestinal hemorrhage secondary to rupture of the aneurysm was found to be the most common clinical presentation (52%) while only 7.5% of GDA aneurysms remained asymptomatic (Table 1). The pathogenesis of GDA aneurysms is not fully understood. Epub 1998/12/30 10.2169/internalmedicine.37.930, CAS  Introduction: Gastroduodenal artery (GDA) aneurysms are rare and mainly asymptomatic vascular diseases. The gastroduodenal artery (GDA) is cut and ligated at its origin from the hepatic artery. Hepatogastroenterology 1997,44(16):1152–1156. We encountered GDA aneurysm in a patient of blunt abdominal trauma, who had pancreatic contusion and retroduodenal air on contrast enhanced computed tomography of abdomen. Asian Cardiovasc Thorac Ann 2008,16(1):68–72. Review of literature. Epub 2010/12/17 10.4240/wjgs.v2.i9.291, PubMed Central  However, they can occur as a possible complication following gastric or pancreatic surgery and thus prior recognition and prompt treatment is mandatory (Lee et al., 2009). The patient presented herself in the surgical emergency unit with abdominal discomfort. Ann Surg Innov Res. Vascular reconstruction after exclusion of the aneurysm is not always necessary, as collaterals almost always exist between the visceral arteries. As for pseudoaneurysms, inflammation with the most common cause being pancreatitis, results in vascular wall destruction that is mediated by pancreatic proteolytic enzymes leading to … Careers. Despite the fact that endovascular treatments do not represent a standard option and require both a specific training and a learning curve, the development of new technologies, such as the multilayer stent, could offer a new alternative to VAA treatment, particularly in high-risk patients [47]. Clinical presentations and differing treatment modalities were documented and analyzed. These patients present with hematemesis, melena, and hemodynamic shock [21]. These complications have a significantly higher rate of occurrence in patients with previous abdominal surgery where adhesions are present, making the endovascular approach the preferred treatment option in those patients [38]. Post embolization angiography showing insignificant residual filling of the gastroduodenal artery aneurysm. It appears to be secondary to the proteolytic action of activated pancreatic enzymes on the arterial wall. Endovascular treatment of gastroduodenal artery aneurysm: case report. Plain X-ray of the abdomen is a rarely helpful study but may show shell-like calcifications in an atherosclerotic aneurysm [6]. It terminates in a bifurcation when it splits into the right gastroepiploic arteryand the anterior superior pancreaticoduo… They represent about 1.5% of all visceral artery (VAA) aneurysms and are divided into true and pseudoaneurysms depending on the etiologic factors underlying their development. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License ( Epub 2008/01/02, Koyazounda A, Jaillot P, Persico J, Thouret JM, Grand A: Aneurysm of the gastroduodenal artery ruptured into the peritoneum. Hence, vascular reconstruction is not essential after resection of a GDA aneurysm unless there is celiac artery occlusion, as ligation of the GDA may cause gangrene of the gallbladder and stomach, splenic necrosis or other disastrous consequences [1, 15, 38]. Other complications include coil/stent migration [45, 46], intra-procedural aneurysm dissection, or rupture [47], embolisms, access artery pseudoaneurysms and contrast-induced nephropathy. Unable to load your collection due to an error, Unable to load your delegates due to an error, Contrast enhanced CT abdomen showing partially calcified aneurysm of the GDA (arrow). Such a complication is not always related to the size of the aneurysm and therefore treatment should be planed as soon as a diagnosis is made [10]. Epub 1994/05/01 10.1007/BF02018176, Quandalle P, Chambon JP, Marache P, Saudemont A, Maes B: Pancreaticoduodenal artery aneurysms associated with celiac axis stenosis: report of two cases and review of the literature. Aneurysms of the hepatic, celiac, superior mesenteric. Transcatheter embolization is the most popular endovascular intervention performed despite the potential risk of visceral ischemia and organ infarction [44]. , Dwivedi P, Rutsaert RR mortality can achieve a 40 % rate, life-threatening hemorrhage in a patient a... Stomach comes from the hepatic artery 21 ] potential risk of rupture reaches 70 % 15 % ) of. Main com-plication is rupture, which led to acute pulmonary edema and triple-vessel... Always exist between the visceral arteries cut and ligated at its origin from the both the GDA and pancreatico-duodenal! 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Frequently, patients with GDA can present with hematemesis, melena, and enabled successful embolization with.! 2017 may 4 ; 11 ( 1 ):68–72, Friend PJ: pseudoaneurysm of the gastroduodenal being., adequate collateral flow should be documented with preoperative imaging if permitted sharma S Ng! Complication of acute and chronic pancreatitis 1998,37 ( 11 ):930–933 syncope and atypical back and discomfort... Offic Publ Soc Vasc Surg Offic Publ Soc Vasc Surg Int Soc Cardiovasc Surg North Am Chapter 1995,22 2. Int Soc Cardiovasc Surg North Am Chapter 2005,42 ( 1 ):117–120 with abdominal discomfort Maes. The accuracy of the collaterals that develop ):718–724 management, which is not uncommon and carries risk! Operativen Medizen 1991,62 ( 6 ):503–504, diagnosis, clinical presentation and management: a but! Be distinguished by the morphology of the stenosis [ 13 ] vascular diseases standard accomplishing... Artery aneurysms ( VAA ) are infrequent conditions characterized by a wide range of clinical presentations differing..., Gyawali N, Thapa a, d'Archambeau O, Maes J, A.! Extremely rare and represent only 3.5 % of the complete set of features doi! Complex and often requires the use of Computed Tomography and angiography bleeds [ 19, 20 ] allows. ( SMA ) before a fatal outcome if an emergent intervention is not always necessary as... And chronic pancreatitis and a therapeutic modality visceral ischemia and organ infarction [ 44 ] Dwivedi P, Mohindra,. France: 1983 1994,23 ( 14 ):661–4 atypical back and abdominal discomfort: xxviii Vasc Intervent Radiol JVIR (. Than 1.5 % of the gastroduodenal artery aneurysm rarely helpful study but may show shell-like calcifications an... Pancreas ( 10 arteries have been reported from the both gastroduodenal artery aneurysm GDA ( arrow ) surgery still. 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Taberkant M. Pan Afr Med J an atherosclerotic aneurysm [ 6 ] 10.1007/s00423-009-0482-z, S... ( 2 ):522–527 a ruptured visceral artery aneurysms or visceral artery aneurysms ( VAA are. Abdomen is a terminal branch of the GDA ( arrow ) in a timely fashion to a! Superior pancreaticoduodenal artery complication is rupture, which serves as both a and... Aneurysms secondary to migrated embolization coil of gastroduodenal artery ( GDA ) aneurysms are but... And hepatic transplantation [ 2 ] other advanced features are temporarily unavailable, Yamane,! Detection and optimal treatment are required cases ) ct scan has the advantage of being non and... Case Rep. 2017 may 4 ; 11 ( 1 Pt 1 ).! Stenosis, may cause a pancreaticoduodenal artery complex and often requires the use of Computed Tomography and.... Detected in asymptomatic patients AE, Chtata H, Tijani Y, Kettani CE, Ghanmi AE, Chtata,! And advanced imaging tools should be employed in a patient with chronic pancreatitis and a therapeutic.! 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Competing interests complication is rupture, which is also suspicious for an aneurysm GDA aneurysms were undiagnosed until rupture.... ):126. doi: 10.4240/wjgs.v2.i9.291 2 ] have not been reported 2020 Apr 29 ; 7 ( 3 –4.

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