Spontaneous Rupture of Gastroduodenal Artery Pseudoaneurysm Following Vigorous Cough (original) (raw)
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Ischémie médullaire, intestinale, et de la fesse après réparation endovasculaire d'anévrysme
Annales de Chirurgie Vasculaire, 2011
Un homme de 66 ans avec des comorbidit es multiples s'est pr esent e avec un an evrysme aortique p eri-anastomotique juxta-r enal 10 ans apr es une r eparation abdominale ouverte d'un an evrysme aortique. La maladie an evrismale atteignait egalement les deux bifurcations iliaques, l'art ere iliaque interne droite, l'art ere f emorale commune gauche (CFA) jusqu' a sa bifurcation, et l'art ere poplit ee homolat erale. Nous avons fait une embolisation bilat erale de l'art ere iliaque interne par spires a un mois d'intervalle. Par la suite, nous avons plac e un stentgraft aortouniiliaque s' etendant a l'art ere iliaque externe droite avec mise en place d'un bouchon endovasculaire dans l'art ere iliaque externe gauche. Un pontage de la CFA droite a la bifurcation f emorale gauche etait alors cr e e apr es ligature de l'an evrysme de la CFA gauche. Apr es la r ecup eration de l'anesth esie et en d epit de l'embolisation hypogastrique s equentielle, le patient a d evelopp e une parapl egie postop eratoire, une isch emie de fesse, et une colite isch emique et est mort a J 5. Les m ecanismes pathog enes possiblement impliqu es dans la survenue de ces complications isch emiques sont discut es dans cet article.
Spontaneous True Gastroduodenal Artery Aneurysm Rupture after an Inguinal Hernia Operation
2018
Gastroduodenal artery aneurysms are a very rare subtype of visceral artery aneurysms. These are divided into two groups as true and pseudoaneurysms. Pseudogastroduodenal artery aneurysms, which develops secondary to pancreatitis, is seen more frequently, whereas the true aneurysms are much less common. Spontaneous rupture may be fatal. Sudden onset of abdominal pain and hypotension are the most important clinical findings. Endovascular interventions are the gold standard for diagnosis. Regardless of their sizes, GDA aneurysms should be treated as soon as possible. In patients diagnosed with gastroduodenal artery aneurysm rupture, endovascular embolization is recommended if the hemodynamics is stable and surgical treatment, if not. Aneurysm ruptures, especially from the GDA divisions, are deeply localized in the pancreas parenchyma and are difficult to detect during the operation. In such cases, the earliest postoperative diagnosis with endovascular intervention and applying emboliza...
Gastroduodenal artery aneurysm rupture in hospitalized patients: An overlooked diagnosis
World journal of gastrointestinal surgery, 2010
Gastroduodenal artery (GDA) aneurysm rupture is a rare serious condition. The diagnosis requires a high level of suspicion with specific attention to warning signs. Early diagnosis can prevent fatal outcomes. In this report, we describe a case of GDA aneurysm rupture presenting as recurrent syncope and atypical back and abdominal discomfort. The rupture manifested as hemorrhagic shock. The diagnosis was made by computed tomography of the abdomen which showed acute peritoneal and retroperitoneal bleeding. Angiographic intervention failed to coil the GDA and surgery with arterial ligation was the definitive treatment.
Annals of Vascular Surgery, 2004
Visceral artery aneurysms (VAA) can be treated by revascularization, ligation, or, most often, endovascular techniques depending on clinical presentation, hemodynamic status, and location. From 1975 to 2002 a total of 42 VAA in 34 patients were treated. The lesion involved the splenic artery (SA; 19), pancreaticoduodenal artery (PDA; 6), celiac trunk (CT; 5), superior mesenteric artery (SNA; 4), common hepatic artery (CHA; 3), gastroduodenal artery (GDA; 2), left hepatic artery (LHA; 1), a branch of the inferior mesenteric artery (BIMA; 1), and a branch of the SMA (BSMA; 1). Twenty-seven VAA in 21 patients (64%) were uncomplicated (group I) and 15 VAA in 13 patients (36%) had ruptured (group II) (PDA; 6; CT, 3; SA, 1; CHA, 1; LHA, 1; BSMA, 1; BIMA, 1). In group I VAA were treated by embolization (n = 11), splenectomy (n = 6), bypass (n = 7), ligation (n = 2), and aneurysmorraphy (n = 1). No deaths were observed. The morbidity rate associated with surgical treatment was 12% including hepatic bypass thrombosis without ischemic complications in two cases. The morbidity rate associated with endovascular treatment was 18% including cholecystitis in one case and bile duct stenosis in one case. The VAA recanalization rate following embolization was 9%. In group II, 12 VAA (80%) were treated by ligation in association with splenectomy in two cases and left hepatectomy in one case. Only one bypass procedure was performed and embolization was used to treat two VAA (1 SMA and 1 PDA). The mortality rate was 20% (3/15). The morbidity rate associated with surgical treatment was 46% (6/13) including bile duct stenosis in one case, ischemic cholecystitis in one case, duodenal fistula in one case, pancreatic fistula in one case, bile tract fistula in one case, and colonic ischemia in one case. No patient died after endovascular treatment and the morbidity rate was 50% (1/2) with duodenal stenosis occurring in one case. In sum, VAA can rupture. Emergency cases can be treated by ligation in most cases or by embolization if the hemodynamic status of the patient allows. Regardless of treatment technique, the morbidity and mortality rate remains high after rupture, especially in cases involving PDA. Embolization can be proposed as a first-line treatment for most VAA. Because of the risk of rupture, endovascular or open repair is warranted for VAA and has a favorable prognosis.
Mezenterik damarların spontan olarak rüptürü çocuklarda çok nadir bir durumdur. Bu çalışmada travma öyküsü olmaksızın akut karın ve hemorajik şok tablosu ile başvuran 14 yaşında ikiz eşi bir erkek çocuk sunulmaktadır. Acil laparotomide a. mezenterika superiorun rüptüre olduğu saptanmış, onarımı denendiyse de ileri derecede vasküler frajilite nedeni ile başarılamamıştır. Tüm orta barsakta nekroz geliştiğinden, duodenumdan inen kolona kadar geniş rezeksiyon yapılması gerekmiş, duodenal ve kolonik uçlar kapatılmıştır. Ameliyat sonrasında abdominal kompartman sendromu, duodenal fistül ve sepsis gelişen hastada üç hafta içerisinde hem kompartman sendromu, hem de fistül kaybolmuştur. İkiz eşinde ve hastamızdaki atipik yüz görünümü, ince cilt yapısı, kanamaya eğilim bulgularının eşliğinde, yapılan histopatolojik incelemenin de desteği ile ameliyattan 4 hafta sonra Ehler Danlos Sendromu Tip IV tanısı konulabilmiştir. Ameliyat sonrası 3. ayda spontan gelişen femoral arteriovenöz fistül konservatif tedavi edilebilmiş, ancak, hasta ince barsak nakli için bekleme listesinde iken beş ay sonra kaybedilmiştir. Abdominal apopleksi olgularında Ehler Danlos Sendromu akılda tutulmalıdır. Bu olgulardaki vasküler komplikasyonların onarımı tip III kollajen anormalliğine bağlı vasküler frajilite nedeni ile mümkün olmayabilir.
Gastroduodenal artery aneurysm, diagnosis, clinical presentation and management: a concise review
Annals of Surgical Innovation and Research, 2013
Gastroduodenal artery (GDA) aneurysms are rare but a potentially fatal condition if rupture occurs. 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. Atherosclerosis and pancreatitis are the two most common risk factors. Making the diagnosis can be complex and often requires the use of Computed Tomography and angiography. The later adds the advantage of being a therapeutic option to prevent or stop bleeding. If this fails, surgery is still regarded as the standard for accomplishing a definite treatment.