Abstract
Gastroduodenal artery aneurysm is a rare condition generally diagnosed incidentally. Once detected, it cannot be ignored due to the high risk for rupture. Endovascular intervention may be a method of effectively treating this condition. We describe elective laparoscopic surgical excision of gastroduodenal artery aneurysm along with cholecystectomy safely performed in an elderly woman.
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Case Summary
A 63-year-old woman visited our outpatient clinic with interrupted epigastric pain throughout the month prior. Physical examination revealed mild tenderness in the right upper quadrant.
An abdominal computed tomography revealed a gastroduodenal artery (GDA) aneurysm 2 cm in diameter and calculous cholecystitis with a stone 1.4 cm in diameter (Fig. 1a and b). Other laboratory tests, including liver function tests, were normal. Because the patient wanted surgical resection of the GDA aneurysm at the same time as a cholecystectomy, endovascular intervention was excluded, and laparoscopic treatment was scheduled Fig. 1.
After conventional laparoscopic cholecystectomy, the common hepatic artery was identified and followed caudally to expose the GDA including the aneurysm. This approximately 2-cm aneurysm was excised by the application of Hemlock clips on the two sides of the aneurysm on the gastroduodenal artery (Figs. 2a and b and 3).
The incidence rate of GDA aneurysm is 1.5–3.5% of all reported visceral artery aneurysms [1]. It presents with little to no symptoms and are often discovered incidentally. However, they could lead to gastric outlet obstruction and other non-specific symptoms, such as vomiting, diarrhea, and jaundice secondary to compressive hematoma or external pressure from the aneurysm.
Once discovered, all GDA aneurysms, regardless of size, must be treated because of their large potential to rupture. Current treatment options include surgical intervention or endovascular intervention. Transcatheter embolization has recently become an increasingly popular choice of treatment, as opposed to surgical resection [2, 3]. Recently, minimally invasive procedures have been applied in vascular surgical interventions [4]. Considerations for surgical resection, including laparoscopic procedures, include the size and location of the aneurysm, as well as patient comorbidities. In our case, laparoscopic resection was the most appropriate treatment option because the GDA aneurysm was relatively small in size, and there was no need for reconstruction due to sufficient collateral vessels around the pancreas, even if it had been removed.
References
White AF, Baum S, Buranasiri S (1976) Aneurysms secondary to pancreatitis. AJR Am J Roentgenol 127:393–6
Hur S, Yoon CJ, Kang SG, Robert D, Han HS, Yoon YS et al (2011) Transcatheter arterial embolization of gastroduodenal artery stump pseudoaneurysms after pancreaticoduodenectomy: safety and efficacy of two embolization techniques. J Vasc Interv Radiol 22:294–301
Kasirajan K, Greenberg RK, Clair D, Ouriel K (2001) Endovascular management of visceral artery aneurysm. J Endovasc Ther 8:150–155
Tiberio GAM, Bonardelli S, Gheza F, Arru L, Cervi E, Giulini SM (2012) Prospective randomized comparison of open versus laparoscopic management of splenic artery aneurysms: a 10-year study. Surg Endosc. https://doi.org/10.1007/s00464-012-2413-2
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Lee, M.R., Do Yang, J. Laparoscopic Resection of a Gastroduodenal Artery Aneurysm. Indian J Surg 84, 1128–1130 (2022). https://doi.org/10.1007/s12262-022-03433-0
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DOI: https://doi.org/10.1007/s12262-022-03433-0