S4674 A Rare Case of Ruptured Gastroduodenal Artery Aneurysm Presenting With Concomitant Gastric Ulcers

Introduction: Gastroduodenal artery (GDA) aneurysms are a rare subset of visceral artery aneurysms representing approximately 1.5% of all cases, and can lead to life-threatening hemorrhage if they rupture. While the precise pathogenesis of visceral artery aneurysms is not well understood, pseudoaneurysms are thought to arise from inflammatory conditions such as pancreatitis, while true aneurysms are more commonly associated with trauma, uncontrolled hypertension, and atherosclerosis. We present a rare case of a GDA aneurysm in a patient later found to have concomitant gastric ulcers. Case Description/Methods: A 74-year-old man with a past medical history of hypertension presented with acute onset severe abdominal pain, distention, and hypotension. A computed tomography angiography (CTA) of the abdomen was obtained which showed a GDA aneurysm with active contrast extravasation and large volume hemoperitoneum. The patient underwent urgent interventional radiology (IR)-guided embolization of the vessel. During the following 2 days post-embolization, the patient continued to have significant drops in hemoglobin requiring multiple blood transfusions despite no further contrast extravasation seen on repeat CTA of the abdomen. The patient subsequently underwent an esophagogastroduodenoscopy (EGD) with endoscopic ultrasound (EUS). EGD revealed 2 small forest type III ulcers without stigmata of recent hemorrhage in the gastric antrum and EUS showed a large non-bleeding GDA aneurysm. Multiple biopsies were obtained of the ulcer margins and the patient was started on high-dose proton pump inhibitor (PPI) therapy. The biopsy results were negative for Helicobacter pylori. His hemoglobin remained stable post-endoscopy and the patient was discharged soon after. Discussion: While GDA aneurysms are rare and often discovered incidentally, aneurysm rupture can be life-threatening. Therapeutic strategies are dependent on when and how the aneurysm was discovered. Endovascular repair is a safe and well-tolerated approach in hemodynamically stable patients, while surgical repair should be considered in cases of hemodynamic compromise. While GDA aneurysms have been associated with peptic ulcer disease, a majority of case reports describe concomitant duodenal ulcers; very few report concomitant gastric ulcerations. Further research is needed to determine the underlying cause of GDA aneurysms and if peptic ulcer disease predisposes patients to visceral artery aneurysms or if screening modalities should be changed.