Anwar Muhammad Naveed, Anthony Nouman, Amin Qazi Kamran, Yousafzai Zaland A, Khalil Hira
Gastroenterology, Rehman Medical Institute, Peshawar, PAK.
General Medicine, Rehman Medical Institue, Peshawar, PAK.
Cureus. 2021 May 1;13(5):e14789. doi: 10.7759/cureus.14789.
Visceral artery aneurysms, which could be either true or pseudo, are abnormal focal dilations of vessels supplying the abdominal organs. True aneurysms, by definition, suggest dilation of the vessel in response to increased blood flow, ultimately causing a blood-filled sac to form. Pseudoaneurysm, however, is the pooling of blood in surrounding tissues secondary to trauma or rupture. A 43-year-old woman G9 P9, known hypertensive was admitted electively for investigation of melena, hematemesis, hematochezia for one week along with weight loss and epigastric pain. Laboratory studies showed mild anemia with a hemoglobin level of 9.6 g/dL, hematocrit 29.5%, mean corpuscular hemoglobin (MCH) 26.7, upon which she was transfused two pints of blood and commenced at Injectable Vitamin K, injectable transamine, and infusion omeprazole. Two days later her levels improved to HB 12.4 g/dL, hematocrit 37.5%, MCH 26.7 pg, RBC 4.64 × 10*12/L. while being on treatment, a computed tomography (CT) mesenteric angiography was also conducted that showed multiple splanchnic pseudoaneurysms involving celiac axis trifurcation, gastroduodenal artery, superior/inferior pancreaticoduodenal artery, and jejunoileal branch of the superior mesenteric artery, and a large partially thrombosed pseudoaneurysm arising from superior pancreaticoduodenal branch causing significant mass effect on the second part of duodenum. On the basis of such findings, it was advised to perform coiling and embolization of the corresponding arteries. Multiple other small aneurysms with secondary arteriovenous malformations (AVM) were also seen. The whole circuit of flow retrograde and antegrade along with the aneurysm sac was blocked with multiple coils of variable sizes. An angiogram was repeated that revealed a good outcome. Pseudoaneurysms of the visceral arteries are very rare and affect mainly the splenic artery. The rarest of which is gastroduodenal artery (1.5%), pancreaticoduodenal artery (2%), and coeliac truck (4%). Therefore, this can be an incidental finding. The diagnosis is usually made with an angiography combined with clinical presentation. Variable treatment options are available depending on the patient's fitness and hemodynamic stability. The endovascular approach, however, is mostly used in such cases.
内脏动脉瘤可分为真性或假性，是供应腹部器官的血管的异常局限性扩张。根据定义，真性动脉瘤是指血管因血流增加而扩张，最终形成充满血液的囊。然而，假性动脉瘤是外伤或破裂后血液在周围组织中的积聚。一名43岁、孕9产9的已知高血压女性因黑便、呕血、便血一周，伴有体重减轻和上腹部疼痛而择期入院检查。实验室检查显示轻度贫血，血红蛋白水平为9.6g/dL，血细胞比容29.5%，平均红细胞血红蛋白量（MCH）26.7，为此她输注了两品脱血液，并开始注射维生素K、注射用转氨酶和输注奥美拉唑。两天后，她的各项指标改善为血红蛋白12.4g/dL，血细胞比容37.5%，MCH 26.7pg，红细胞4.64×10¹²/L。在治疗期间，还进行了计算机断层扫描（CT）肠系膜血管造影，结果显示多个内脏假性动脉瘤，累及腹腔干三叉分支、胃十二指肠动脉、胰十二指肠上/下动脉以及肠系膜上动脉的空肠回肠分支，还有一个源于胰十二指肠上分支的巨大部分血栓形成的假性动脉瘤，对十二指肠第二部产生了明显的占位效应。基于这些发现，建议对相应动脉进行弹簧圈栓塞治疗。还发现了多个其他伴有继发性动静脉畸形（AVM）的小动脉瘤。用多个不同大小的弹簧圈阻断了整个动脉瘤囊的顺行和逆行血流回路。再次进行血管造影显示效果良好。内脏动脉假性动脉瘤非常罕见，主要影响脾动脉。其中最罕见的是胃十二指肠动脉（1.5%）、胰十二指肠动脉（2%）和腹腔干（4%）。因此，这可能是一个偶然发现。诊断通常通过血管造影结合临床表现来做出。根据患者的身体状况和血流动力学稳定性，有多种治疗选择。然而，在这种情况下大多采用血管内治疗方法。
