Ruptured Pseudoaneurysm of the Gastroduodenal Artery Revealed by Massive Digestive Hemorrhage: Haemostasias by Embolization

Gastroduodenal artery pseudoaneurysm is a rare vascular complication, often asymptomatic. However, if the aneurysm ruptures, the prognosis is poor with mortality rates reaching 40%. We report the case of a 30-year-old patient, who underwent surgery for insulinoma and received pancreatic nodule enucleation. Within one month postoperatively, she experienced massive gastrointestinal bleeding characterized by hematemesis and rectal bleeding, with stable hemodynamics, along with diffuse abdominal pain exacerbated in the epigastric region. Endoscopy revealed erythematous and pseudo-nodular pangastritis with active bleeding through the papilla. An emergency abdominal angio-scan revealed a pseudoaneurysm of the gastroduodenal artery in intimate contact with the duodenal wall (D2), associated with multiple peri-pancreatic collections. Vascular embolization was proposed and consisted of excluding the aneurysm, yielding favorable postoperative outcomes.