Delayed post-traumatic left gastric artery pseudoaneurysm presenting with massive upper gastrointestinal hemorrhage:...

Post-traumatic visceral artery pseudoaneurysms are rare vascular entities but carry a high risk of catastrophic hemorrhage. They most commonly involve the hepatic artery, while pseudoaneurysms of the left gastric artery are exceptionally uncommon. Delayed presentation several years after trauma is particularly rare and poses significant diagnostic challenges.

We report the case of a 37-year-old woman who presented with massive hematemesis and hemodynamic instability. She had a history of childhood abdominal trauma following a road traffic accident requiring partial splenectomy and reported vague abdominal pain in the weeks preceding the event. Initial differential diagnoses included peptic ulcer bleeding and esophageal varices. Upper gastrointestinal endoscopy revealed a large amount of intragastric blood without an identifiable source. Contrast-enhanced CT angiography demonstrated a saccular pseudoaneurysm of the left gastric artery with tortuous vessels. During preparation for endovascular embolization, the patient developed recurrent massive hemorrhage requiring emergency laparotomy. Intraoperative findings confirmed rupture into the gastric lumen, and hemostasis was achieved by ligation of the left gastric artery. The postoperative course was uneventful, and the patient was discharged in stable condition.

Visceral artery pseudoaneurysms should be considered in unexplained gastrointestinal bleeding, particularly in patients with prior abdominal trauma. CT angiography is essential for diagnosis and guides management. Endovascular embolization is preferred in stable patients, whereas active rupture requires urgent surgical intervention.

Delayed post-traumatic pseudoaneurysms should be included in the differential diagnosis of severe gastrointestinal hemorrhage. Early recognition, prompt imaging, and timely intervention are crucial to improve outcomes.