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Bhusal A, Katwal S, Jha SK, Oli R, Bam PK. Spontaneous rupture of Gastroepiploic artery aneurysm in a young female: A case report. Radiol Case Rep 2024; 19:6076-6079. [PMID: 39380828 PMCID: PMC11458920 DOI: 10.1016/j.radcr.2024.08.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 08/22/2024] [Accepted: 08/23/2024] [Indexed: 10/10/2024] Open
Abstract
Gastroepiploic artery aneurysms (GEAAs) are rare subtype of Splanchnic artery aneurysms (SAAs) with estimated prevalence of 0.4% out of total SAAs. Most common causes include atherosclerosis, trauma, vasculitis, infections, pancreatitis, biliary diseases etc. GEAAs are more common in male and the rupture occurs usually after 50 years. Spontaneous rupture of GEAAs in females are rare and very less cases have been reported till now. A 35 years old female with no significant past medical history and no history of trauma presented to ED with features suggestive of shock. CECT (axial and coronal plane) revealed a focal outpouching in right gastroepiploic artery with evidence of active contrast extravasation suggestive of spontaneous rupture of Right Gastroepiploic artery aneurysm. Patient was resuscitated and Exploratory Laparotomy along with ligation and aneurysmectomy. Spontaneous rupture of GEAAs in young female is very rare. Urgent treatment is needed in case of unstable patients because of high risk of rupture and higher mortality rates of GEAAs.
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Affiliation(s)
- Amrit Bhusal
- Department of Radio-diagnostics and Imaging, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Shailendra Katwal
- Department of Radiology, Dadeldhura Subregional Hospital, Dadeldhura, Nepal
| | - Saurav Kumar Jha
- Department of Radiology, Chitwan Medical College Teaching Hospital, Chitwan, Nepal
| | - Rabindra Oli
- Department of Radiology, Nepal Medical College and Teaching Hospital, Nepal
| | - Prabin Kumar Bam
- Department of Radiology, Chitwan Medical College Teaching Hospital, Chitwan, Nepal
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Kimura S, Mikami S, Takagi S, Shimada J, Enomoto T, Otsubo T. Presentation of unruptured right gastric aneurysm due to segmental arterial mediolysis resected laparoscopically: A case report. Int J Surg Case Rep 2024; 114:109183. [PMID: 38154231 PMCID: PMC10800682 DOI: 10.1016/j.ijscr.2023.109183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Timely diagnosis and treatment of intra-abdominal arterial aneurysms before rupture are highly recommended. We successfully prevented rupture through arterial aneurysm excision, highlighting the importance of the lack of reports on resection before rupture. CASE PRESENTATION A 60-year-old male with previous history of ureteral stones presented complaining primarily of left-sided abdominal pain. Computed tomography (CT) revealed a left ureteral stone and incidentally identified a submucosal gastric tumor and right gastric artery aneurysm, leading to referral to our department. Blood tests showed no abnormalities. CT revealed a 23-mm submucosal tumor protruding outward from the middle gastric body wall. A 13-mm aneurysm was observed in the right gastric artery, and no other aneurysms were detected, including intracranially. Upper gastrointestinal endoscopy revealed a smooth elevation covered by normal mucosa in the middle gastric body. Endoscopic ultrasound-fine needle aspiration resulted in a diagnosis of gastrointestinal stromal tumor (GIST) and surgery. We performed simultaneous surgery involving laparoscopic local resection of the gastric GIST and identification and excision of the right gastric artery aneurysm due to its enlargement (7 mm on CT conducted six years ago). The patient's postoperative course was uneventful, and he was discharged on postoperative day 6. Pathological examination confirmed a diagnosis of segmental arterial mediolysis. DISCUSSION Intra-abdominal arterial aneurysms affect approximately 1 % of the population. Splenic artery aneurysms are the most common at 58.7 %, whereas the gastric artery and gastroepiploic artery account for only 4.7 %. CONCLUSION Right gastric artery aneurysms are exceedingly rare, with no reported cases of successful resection before rupture.
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Affiliation(s)
- Sae Kimura
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan.
| | - Shinya Mikami
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan.
| | - Shimpei Takagi
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan.
| | - Jin Shimada
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan.
| | - Takeharu Enomoto
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan.
| | - Takehito Otsubo
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan.
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Takahashi K, Ohyama H, Mikata R, Nagashima H, Ohno I, Takiguchi Y, Kato N. Intraperitoneal bleeding from the right gastroepiploic artery by endoscopic ultrasonography: a case report. J Rural Med 2022; 17:184-188. [PMID: 35847751 PMCID: PMC9263947 DOI: 10.2185/jrm.2022-002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/29/2022] [Indexed: 11/27/2022] Open
Abstract
Objective: To describe the case of a patient with intraperitoneal bleeding
from the gastroepiploic artery by endoscopic ultrasound who was successfully treated with
transcatheter arterial coil embolization. Patient and Methods: An 87-year-old man was referred to our hospital for
examination of a gallbladder tumor. Endoscopic ultrasonography was performed using an
oblique-view echoendoscope. After the endoscopic ultrasound, the patient went into shock.
Computed tomography revealed a huge intraperitoneal hematoma and an aneurysm in the right
gastroepiploic artery that were not seen on previous computed tomography images. Thus,
urgent catheter angiography was performed, which showed a pseudoaneurysm of the right
gastroepiploic artery and extravasation of the contrast medium from the
pseudoaneurysm. Results: Transcatheter arterial coil embolization was subsequently
performed, and the bleeding stopped. Thereafter, his hemodynamics stabilized and his
general condition improved. The patient was discharged 22 days post-treatment with an
uneventful course. Conclusion: Observation-only endoscopic ultrasound without invasive
procedures can cause intraperitoneal bleeding due to a ruptured splanchnic artery. Thus,
endoscopic ultrasonography should be performed more carefully in elderly patients.
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Affiliation(s)
- Koji Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Hiroshi Ohyama
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Rintaro Mikata
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Hiroki Nagashima
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Izumi Ohno
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Yuichi Takiguchi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
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Jung DY, Jung HK, Ko YM, Lee A, Hong JT, Moon CM, Kim SE, Tae CH, Shim KN, Jung SA, Kim R, Choi SY. Spontaneous Rupture of the Right Gastroepiploic Artery Immediately after Gastroscopy. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2021. [DOI: 10.7704/kjhugr.2021.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Idiopathic spontaneous intraperitoneal hemorrhage is both rare and potentially fatal. The incidence of gastroepiploic artery rupture, especially a non-aneurysmal rupture, is extremely low. We report the case of an elderly woman who was mistakenly diagnosed with procedure-related bleeding after gastroscopy. A 0.3 cm polyp was identified and removed during the procedure. The patient later developed shock due to which gastroscopy was repeated; however, no unusual findings were observed. Therefore, abdominopelvic computerized tomography was performed and gastroepiploic artery rupture was detected. Transcatheter arterial embolization was immediately performed without laparotomy, without any complications. The bleeding was controlled, and the patient was discharged after embolization. It is important to acknowledge the possibility of spontaneous rupture of the visceral arteries in elderly individuals with hypertension or atherosclerosis, especially in the event of sudden abdominal pain or shock immediately after an endoscopic procedure. This is the first case report of idiopathic spontaneous rupture of the right gastroepiploic artery successfully managed by transcatheter arterial embolization in South Korea.
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Ishimine T, Tengan T, Nakasu A, Takara H. Successful transcatheter arterial embolization of a ruptured right gastroepiploic artery aneurysm: A case report. Int J Surg Case Rep 2018; 51:158-160. [PMID: 30172054 PMCID: PMC6122313 DOI: 10.1016/j.ijscr.2018.08.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/18/2018] [Accepted: 08/20/2018] [Indexed: 11/23/2022] Open
Abstract
GEAAs are extremely rare. We describe a case of a ruptured right GEAA treated by TAE. An elderly woman with abdominal pain was diagnosed as having a ruptured right GEAA. The patient was at high risk for surgery so we performed TAE for the ruptured GEAA. The patient had an uneventful recovery and was discharged 10 days after TAE.
Background Gastroepiploic artery aneurysms (GEAAs) are extremely rare. Ruptured GEAAs are related to high mortality and often treated by open surgery. We describe a case of a ruptured right GEAA that was successfully treated by transcatheter arterial embolization (TAE). Presentation of case An 80-year-old woman presented to the emergency department with sudden abdominal pain. We diagnosed her as having a ruptured right GEAA based on the contrast-enhanced computed tomography finding. We performed TAE for the GEAA after resuscitation. The patient had an uneventful recovery and was discharged 10 days after TAE. Discussion A ruptured GEAA causes high mortality; thus, immediate and adequate treatment is mandatory. Previously, many cases of successful surgical resections of ruptured GEAAs have been reported. In our case, we decided that the patient was not suitable for surgery because of her advanced age and bronchiectasis; therefore, we performed TAE and had a good outcome. Conclusion In patients at high risk for surgery, TAE can be an effective treatment for a ruptured GEAA.
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Affiliation(s)
- Tohru Ishimine
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, 281, Miyazato, Uruma-shi, Okinawa 904-2293, Japan.
| | - Toshiho Tengan
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, 281, Miyazato, Uruma-shi, Okinawa 904-2293, Japan
| | - Akio Nakasu
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, 281, Miyazato, Uruma-shi, Okinawa 904-2293, Japan
| | - Hiroaki Takara
- Department of Radiology, Okinawa Prefectural Chubu Hospital, 281, Miyazato, Uruma-shi, Okinawa 904-2293, Japan
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Pisavadia B, Hanif M, Rana K, Budhoo M, Zaman S. A rare case of haemorrhagic shock secondary to spontaneous rupture of a branch of the left colic artery and the right gastric artery. Ann R Coll Surg Engl 2018; 100:e125-e127. [PMID: 29658342 DOI: 10.1308/rcsann.2018.0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spontaneous splanchnic artery rupture is associated with up to 70% mortality. Affected vessels are often aneurysmal, secondary to atherosclerosis. We report, to our knowledge, the only case of spontaneous rupture of a branch of the left colic artery and the right gastric artery, possibly secondary to vasculitis.
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Affiliation(s)
- B Pisavadia
- Sandwell General Hospital , Lyndon, West Bromwich , UK
| | - M Hanif
- Sandwell General Hospital , Lyndon, West Bromwich , UK
| | - K Rana
- Sandwell General Hospital , Lyndon, West Bromwich , UK
| | - M Budhoo
- Sandwell General Hospital , Lyndon, West Bromwich , UK
| | - S Zaman
- Sandwell General Hospital , Lyndon, West Bromwich , UK
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