Korean J Med.  2016 Dec;91(3):277-282. 10.3904/kjm.2016.91.3.277.

Chronic Hemorrhage from a Fistula between a Gastroduodenal Artery Aneurysm and the Duodenum

• Kim IT
• Choi JS
• Kim PS
• Song SY
• Kim YJ

• KMID: 2361433
• DOI: http://doi.org/10.3904/kjm.2016.91.3.277

Abstract

Gastroduodenal artery (GDA) aneurysm is a very rare event, but it induces life-threatening clinical manifestations upon rupture or bleeding. The causes of GDA aneurysm are atherosclerosis, infection, trauma, surgery, iatrogenic lesions, mycotic or tuberculous disease, and autoimmune disease. We report the case of a 77-year-old female who presented with melena and vomiting. Upper gastrointestinal endoscopy revealed a 4 cm pulsatile extrinsic mass with a duodenal fistula at the duodenal bulb. Abdominal computed tomography showed a large aneurysm of the GDA. We successfully conducted transcatheter embolization of the aneurysm. After the procedure, the patient did not present with melena, and her hemoglobin level was stable. Follow-up endoscopy showed that the GDA aneurysm-duodenal fistula had decreased in size and was leaking a small amount of blood. An arteriography was performed and showed no evidence of contrast filling in the aneurysmal sac.

Keyword

Aneurysm, Ruptured; Intestinal fistula; Embolization, Therapeutic

MeSH Terms

Aged
Aneurysm*
Aneurysm, Ruptured
Angiography
Arteries*
Atherosclerosis
Autoimmune Diseases
Duodenum*
Embolization, Therapeutic
Endoscopy
Endoscopy, Gastrointestinal
Female
Fistula*
Follow-Up Studies
Hemorrhage*
Humans
Intestinal Fistula
Melena
Rupture
Vomiting