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.

Fig. 1
figure 1

Abdominal contrast enhanced computed tomography reveals a gallbladder stone (yellow arrow) and gastroduodenal artery aneurysm (red arrow)

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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).

Fig. 2
figure 2

Intraoperative images showing laparoscopic aneurysmal dissection and resection

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Fig. 3
figure 3

Histological examination revealed marked atheromatous changes accompanied by calcification in the resected aneurysm

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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.