Cause rare d’hémorragie digestive haute: rupture d’un faux anévrisme de l’artère gastroduodénale

A 69-year-old female patient with diabetes and hypertension on treatment presented in the emergency department with haematemesis. She reported intermittent epigastric pain evolving for a few days. Clinical examination only showed epigastric susceptibility. Laboratori tests revealed severe normocytic normochromic anemia (Hb=8.3 gr/dl), normal amylasemia with preservation of liver function and coagulation. Patient´s outcome was marked by decline in haemoglobin concentrations and haemodynamic instability despite good venous filling and blood transfusion. Given the nonavailability of urgent digestive endoscopy, abdominal angioscan showed gastroduodenal artery pseudoaneurysm measuring 6mm along its longer axis without signs of active leakage or intraperitoneal effusion, associated with choledocoduodenal fistula. The diagnosis of heavy upper gastrointestinal bleeding secondary to gastroduodenal artery pseudoaneurysm rupture was retained. The patient underwent emergency surgery given the nonavailability of arterial embolization through vascular ligation. Patient´s outcome was favorable with stabilization of haemoglobin level and hemodynamic status.