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


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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


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