[Aneurysm of the gastroduodenal artery ruptured into the peritoneum. Treatment by embolization]

Aneurysms rarely occur in the gastroduodenal artery. We encountered such an aneurysm which bled into the peritoneum leading to a difficult diagnostic situation. A 58-year-old man was hospitalized for acute abdominal 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 laboratory tests the diagnosis of acute pancreatitis was entertained, but after the haemodynamic situation was reestablished by intravenous fluids, 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 haematoma. Arteriography rapidly demonstrated an aneurysm of the gastroduodenal artery. Embolization was preferred over surgery due to the precarious haemodynamic situation. Outcome was quite favourable and no complications have been observed with a follow-up of 6 months. Reports of true aneurysms of the gastroduodenal artery are rare but clinical manifestations are usually latent or absent. Reported complications include massive digestive haemorrhage and rarely jaundice, haemobilia or wirsungorrhagia due to compression. Excepting recognized trauma, few aetiological factors have been determined. Fragile arterial walls due to atheroma, isolated dysplasia or connective tissue disease appear to be damaged by successive systolic distension leading to rupture of certain elements of the arterial wall and finally aneurysm. Embolization carries less risk than surgical repair but must be indicated only after precise characterization including localization, size and local involvement.