Upper gastrointestinal bleeding due to hepatic artery pseudoaneurysm in a patient with systemic lupus erythematosus

Inflammation of the vessels can result in the development of arterial aneurysms in patients with systemic lupus erythematosus (SLE). We present case of a 46 years-old women with SLE who developed three episodes of upper gastrointestinal (GI) bleeding due to hepatic artery pseudoaneurysm. Upper GI endoscopy showed a pulsating submucosal protrusion in the duodenal bulb. Abdominal ultrasound showed cystic lesions located at the hylus of the liver. On day 3 of admission, she had massive hematemesis again. Within the 24 hours hemoglobin level dropped from 10,5 g/dl to 5,5 g/dl despite several blood transfusion. Angiography of the celiac artery showed a 2x3 cm aneurysm originating from the common hepatic artery and the bleeding arose from rupture of a common hepatic artery aneurysm. Patient transfered to surgery for treatment and performed ligation of artery ligation. She died on the 10th postoperative day.

___

D'Cruz D. Vasculitis in systemic lupus erythematosus. Lupus. 1998;7(4):270-4.

Vernadakis S, Christodoulou E, Treckmann J, Saner F, Paul A, Mathe Z. Pseudoaneurysmal rupture of the common hepatic artery into the biliodigestive anastomosis. A rare cause of gastrointestinal bleeding. JOP. 2009;10(4):441-4.

Papafragkou S, Haimovici L, Gonzalez E, Barrett L, Cirincione E. Hepatic Artery Aneurysm Erosion into the Stomach: An Unusual Cause of Gastrointestinal Bleeding. J Emerg Med. 2010;39(1):32-4

Abbas MA, Fowl RJ, Stone WM, Panneton JM, Oldenburg WA, Bower TC, Hepatic artery aneurysm: factors that predict complications. J Vasc Surg. 2003;38(1):41-5.

O'Driscoll D, Olliff SP, Olliff JF. Hepatic artery aneurysm. Br J Radiol. 1999;72(862):1018-25.

de Castro SM, Busch OR, Gouma DJ. Management of bleeding and leakage after pancreatic surgery. Best Pract Res Clin Gastroenterol. 2004;18:847-64.

Otah E, Cushin BJ, Rozenblit GN, Neff R, Otah KE, Cooperman AM. Visceral artery pseudoaneurysms following pancreatoduodenectomy. Arch Surg. 2002;137(1):55-9.

Sato N, Yamaguchi K, Shimizu S, Morisaki T, Yokohata K, Chijiiwa K, Tanaka M. Coil embolization of bleeding visceral pseudoaneurysms following pancreatectomy: the importance of early angiography. Arch Surg. 1998;133(10):1099-102.
Medicine Science-Cover
  • ISSN: 2147-0634
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2012
  • Yayıncı: Effect Publishing Agency ( EPA )