Ruptured Left Gastric Artery Aneurysms: Three Cases Managed Successfully with Open Surgical Repair

Visceral artery aneurysms (VAAs) are an uncommon vascular pathology with an incidence estimated at 0.01-2%. The likely etiology of VAAs is uncertain, which includes atherosclerosis, trauma, and inflammation. VAAs are often asymptomatic until rupture which causes life-threatening hemorrhage and are associated with a high mortality. Gastric artery aneurysms (GAA) form a very small proportion of VAAs (<4%).

This is a case series of 3 patients who presented to the Nambour Hospital with a ruptured left gastric aneurysm. They each presented with acute abdominal pain and hemodynamic instability with imaging revealing a ruptured left gastric artery aneurysm and hemoperitoneum. Patients 1 and 2 received open surgical repair in the first instance, while Patient 3 was managed endovascularly initially and proceeded to open repair due to ongoing hemorrhage.

Management of ruptured VAAs can be by either open surgical or endovascular means. The advantages of open exploration in the emergency setting include the ability to directly inspect the gastric wall and other viscera and to evacuate hematoma. Additionally, it does not require the use of an angiographic suite. We feel that open repair remains an important means of managing a ruptured GAA, particularly in the shocked patient.