Bleeding pseudoaneurysms in postoperative upper gastrointestinal surgery patients: a single -center experience

Visceral artery pseudoaneurysms are rare but life-threatening complications following upper gastrointestinal (GI) surgery. This case series reviews six patients (male-to-female ratio 3:3) who developed pseudoaneurysms, presenting with diverse clinical manifestations. Four patients (66.6%) experienced bleeding, including hemoperitoneum and upper GI bleeding, with one also reporting nausea and vomiting. Two patients (33.3%) developed anastomotic site leakage, leading to hemoperitoneum in one and bile-induced intra-abdominal infection in the other. The pseudoaneurysms involved the proper hepatic artery (n = 3), common hepatic artery (n = 2), right hepatic artery (n = 1), jejunal artery (n = 1), and splenic artery (n = 1). All patients underwent interventional radiology procedures, with angioembolization performed in each case. Recurrent bleeding required re-embolization in three cases: two from previously treated sites and one from a new pseudoaneurysm. Bleeding occurred between the 5th and 27th postoperative days, and one patient succumbed. Early diagnosis and timely endovascular management are critical for improved outcomes in these patients.