Ruptured gastroepiploic artery aneurysm causing massive intraperitoneal hemorrhage: A case report and literature review

Visceral artery aneurysms, including gastroepiploic artery aneurysms, are a rare cause of gastrointestinal bleeding. Gastroepiploic artery aneurysms are usually silent with a high chance of rupture and hemorrhage. We present a case of a man with a ruptured gastroepiploic artery aneurysm following a fall from standing height. On arrival, he was hypotensive with an acute abdomen. Due to hemodynamic instability and a positive FAST exam, an exploratory laparotomy was performed, which revealed pulsatile bleeding at the greater curvature of the stomach and a subserosal hematoma with an active bleeding vessel visible. The gastroepiploic vessels were ligated, and a partial gastrectomy was performed. He recovered well and was discharged after five days. Gastroepiploic artery aneurysms are a rare occurrence, most commonly occurring in males over the age of 50. Causes include arterial dysplasia, perivascular inflammation, and trauma. Trauma was likely the cause in this patient’s case. Most gastroepiploic artery aneurysms are asymptomatic. They are usually found incidentally or once complications arise. Patients with ruptured gastroepiploic artery aneurysms usually present with peritoneal signs and shock. All patients with gastroepiploic artery aneurysms should be treated immediately due to the risk of rupture and subsequent complications. A variety of techniques exist to treat these aneurysms. Although visceral artery aneurysms are uncommon, they can be life-threatening. Therefore, it is important to remember them as a potential source of intraperitoneal hemorrhage, even from minor trauma.