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117 RUPTURED LEFT GASTRIC ARTERY ANEURYSM: A RARE CAUSE OF UPPER GASTROINTESTINAL BLEEDING W Afif, AN Barkun INTRODUCTION: Gastric artery aneurysms (GAA) are uncommon and account for fewer than 4% of all visceral artery aneurysms. Approximately half of all GAA are found in the left gastric artery. They are thought to arise from either atherosclerosis or medial wall degeneration. They usually remain undiagnosed and are found incidentally or in the context of clinical symptoms when they rupture. Clinical presentations include intraluminal rupture with acute gastrointestinal (GI) bleeding, intraperitoneal rupture, and rarely, rupture into the pleural space. Upper GI bleeding from a ruptured GAA is a rare and life threatening event.
Division of Gastroenterology, McGill University, Montréal, Québec
CASE: We describe the case of an 81 year old male on coumadin (for atrial fibrillation), with a previously documented incidental finding of a left GAA, presenting with massive upper GI bleeding. Anticoagulation was reversed and urgent gastroscopy revealed a large bulging mass protruding into the lumen with associated blood clot in the lesser curvature of the stomach. Angiogram of the celiac axis was performed but embolization of the involved vessels was unsuccessful. An urgent operation was performed; a 6.5 cm gastric artery aneurysm was ligated and gastrotomy revealed a 2 cm aneurysm fistula which was sutured.
CONCLUSION: Although rupture of a GAA has been described previously, we present this case with detailed radiological imaging (CT and angiogram), as well as with photographic imaging, providing rare additional corresponding endoscopic and intra-operative surgical correlates. This case report helps to highlight the management of GAA as rare cause of upper GI bleeding.