Xiao Peiguang, Guo Maodong, Zhu Lujian
Department of Gastroenterology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People's Republic of China.
Department of Infectious Diseases, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People's Republic of China.
J Inflamm Res. 2024 Jun 21;17:4017-4025. doi: 10.2147/JIR.S467969. eCollection 2024.
Significant gastrointestinal hemorrhages, resulting from long-term compression of the duodenum by a hepatic pseudoaneurysm (HAPA), is an extremely rare condition. In fact, when the pseudoaneurysm is small in diameter, diagnosis can be particularly challenging. Timely and effective diagnosis and treatment is therefore of great significance, and in this case, endoscopy, combined with intravascular therapy, can provide an effective approach, especially since it removes the need for surgery while yielding favorable outcomes.
A 75-year-old old man presented to the hospital's emergency department with hematemesis and black stool. Despite conservative treatments such as "acid suppression, fluid resupply, hemostasis and blood transfusion", no significant improvement was noted. Emergency gastroscopy subsequently revealed an ulcer in the duodenal bulb (Figure 1), with an exposed thrombotic head and active bleeding on the surface. In addition, abdominal computed tomography (Figure 2) showed no obvious HAPA manifestations. After unsuccessful endoscopic hemostasis, angiography was performed (Figure 3) and a pseudotumor-like dilatation measuring 5.56 mm in diameter was found at the distal end of the proximal branch vessel of the common hepatic artery. Following spring coil embolization (Figure 4), the patient's condition improved and he was discharged from the hospital, with a follow-up after six months showing no signs of recurrence or complications.
Duodenal ulcer hemorrhages due to small hepatic pseudoaneurysms are very rare, with endoscopic intervention being effective for such cases.
肝假性动脉瘤（HAPA）长期压迫十二指肠导致严重胃肠道出血是一种极其罕见的病症。事实上，当假性动脉瘤直径较小时，诊断会极具挑战性。因此，及时有效的诊断和治疗具有重要意义，在这种情况下，内镜检查结合血管内治疗可提供一种有效的方法，特别是因为它无需进行手术且能取得良好效果。
一名75岁男性因呕血和黑便被送至医院急诊科。尽管采取了“抑酸、补液、止血和输血”等保守治疗措施，但未见明显改善。随后的急诊胃镜检查发现十二指肠球部有一处溃疡（图1），表面有暴露的血栓头且有活动性出血。此外，腹部计算机断层扫描（图2）未显示明显的HAPA表现。内镜止血失败后，进行了血管造影（图3），在肝总动脉近端分支血管远端发现一个直径为5.56毫米的假肿瘤样扩张。弹簧圈栓塞术后（图4），患者病情好转并出院，六个月后随访未发现复发或并发症迹象。
小肝假性动脉瘤导致的十二指肠溃疡出血非常罕见，内镜干预对此类病例有效。
