RUPTURE OF AN ANEURYSM OF THE GASTRODUODE NAL ARTERY INTO THE PERITONEUM - TREATMENT BY EMBOLIZATION

Aneurysms rarely occur in the gastroduodenal artery. We encountered su ch an aneurysm which bled into the peritoneum leading to a difficult d iagnostic situation. A 58-year-old man was hospitalized for acute abdo minal pain. Past history included alcohol intake (wine, 3/4 litre per day) and moderate increase in serum gamma-glutamyl transferase levels (100 IU/L). At admission there was abdominal contracture, vomiting and shock (blood pressure 70 mmHg). Based on the clinical picture and lab oratory tests the diagnosis of acute pancreatitis was entertained, but after the haemodynamic situation was reestablished by intravenous flu ids, echography and computed tomography of the abdomen failed to give confirmation. An effusion however was seen in the peritoneum together with a large mass in the head of the pancreas compatible with a haemat oma. Arteriography rapidly demonstrated an aneurysm of the gastroduode nal artery. Embolization was preferred over surgery due to the precari ous haemodynamic situation. Outcome was quite favourable and no compli cations have been observed with a follow-up of 6 months. Reports of tr ue aneurysms of the gastroduodenal artery are rare but clinical manife stations are usually latent or absent. Reported complications include massive digestive haemorrhage and rarely jaundice, haemobilia or wirsu ngorrhagia due to com pression. Excepting recognized trauma, few aetio logical factors have been determined. Fragile arterial walls due to at heroma, isolated dysplasia or connective tissue disease appear to be d amaged by successive systolic distension leading to rupture of certain elements of the arterial wall and finally aneurysm. Embolization carr ies less risk than surgical repair but must be indicated only after pr ecise characterization including localization, size and local involvem ent.