Aneurysms of the gastroduodenal artery: a case report.
Aneurysms of the gastroduodenal artery are the rarest of all splanchnic artery aneurysms. A case of gastroduodenal artery aneurysm diagnosed preoperatively and successfully managed surgically is described. A 68-year-old woman was admitted to our institution as a result of recurrent epigastric pain. Arteriography of the coeliac trunk and of the upper mesenteric artery showed a coeliac axis occluded at the origin and a voluminous round aneurysmatic formation of the gastroduodenal artery measuring approx. 3 cm. Such lesions may be asymptomatic and initially pass unnoticed or may appear only on rupturing with a profile of haemoperitoneum. The preoperative diagnosis is difficult: in many cases only non-specific signs such as pain, jaundice or upper digestive tract haemorrhage are present. Selective arteriography, in this case, permitted the definitive diagnosis of a gastroduodenal aneurysm, as well as establishing its size and morphology and the vascular pattern of the lesions, all of which was of great assistance in selecting the surgical strategies to be adopted. The operation consisted in the proximal and distal ligation of the gastroduodenal artery and in resection of the aneurysm after preparation of the portal vein, the common hepatic artery and the VBP. We maintain that, because of the risk of rupture of the aneurysm, which so often has a fatal profile, an aggressive surgical approach is both justifiable and advisable.