Pseudoaneurysm of gastroduodenal artery due to duodenal ulcer causing jaundice and interstitial pancreatitis but not gastrointestinal bleeding

Abstract

Aneurysms and pseudoaneurysms of the gastroduodenal artery are rare with less then 50 cases reported. Most frequently they are one of the consequences of pancreatitis much rarer duodenal ulcer or operative trauma during gastrectomy for duodenal ulcer or choledochotomy. We report on a 47 year-old man, chronic heavy alcohol consumer in whom a chronic postbulbar duodenal ulcer destroyed much of the back wall of the duodenum, eroded gastroduodenal artery causing pseudo-aneurysm but without noticeable gastrointestinal bleeding. The patient had jaundice of obstructive type and elevated amilase. After Billroth II gastrectomy, suture of the gastroduodenal artery, cholecystectomy and T tube drainage of the common bile duct the patient developed intestinal obstruction caused by two interintestinal abscesses so that he had to be reoperated. After that he had a successful recovery, his general health greatly improved, he gained 15 kg in weight but two years after surgery he again started with heavy drinking and soon died due to serious brain damage. The case is rare and unusual at least for few reasons: First, the pseudoaneurysm was caused by duodenal ulcer. Second, a serious gastrointestinal bleeding did not take place. Third, the pseudoaneurysm was diagnosed by Doppler ultrasonography while angiography failed to opacity it due to thrombosis of the artery.Aneurizme i pseudo-aneurizme gastroduodenalne arterije su retke, sa nesto manje od 50 opisanih slucajeva. Vecinom su posledica pankreatitisa, znatno redje ulkusa ili operacije ulkusa duodenuma i holedoholitijaze. Autori prikazuju muskarca starog 47 godina, hronicnog etilicara, kod koga je postbulbarni kalozni ulkus razorio zadnji zid duodenuma i erodirao gastroduodenalnu arteriju, sto je dovelo do formiranja pseudoaneurizme, koja je dovela do ikterusa i intersticijalnog pankreatitisa, a da pri tome nije doslo do ozbiljnijeg gastrointestinalnog krvavljenja. Bolesnik je uspesno operisan i u daljem toku je bio bez tegoba. Dobio je oko 15 kg na tezini, ali je dve godine posle operacije, tokom teske visednevne alkoholisanosti doslo do ostecenja centralnog nervnog sistema usled cega je ubrzo umro. Slucaj je redak i neobican bar po tome sto uprkos komunikaciji pseudoaneurizme s duodenumom nije doslo do ozbiljnijeg digestivnog krvavljenja i sto je pseudoaneurizma dijagnostikovana Dopler ultrasonografijom, dok, zbog tromboze gastroduodenalne arterije, angiografija nije prikazala pseudoaneurizmu.