A52-04 Hidden Hemorrhage: Hemoperitoneum From a Gastroepiploic Artery Pseudoaneurysm Rupture

Introduction Gastroepiploic artery aneurysms and pseudoaneurysms (GEAP) are rare, making up approximately 3-5% of all visceral aneurysms. Though patients may remain asymptomatic, abdominal discomfort and acute rupture are the most common presenting symptoms. GEAPs have an estimated risk of rupture and mortality reaching up to 80% and 100%, respectively, depending on their location. Here we share a case of a patient who presented with and survived a rupture of a gastroepiploic artery pseudoaneurysm. Case Presentation Our patient is a 70-year-old obese male with a past medical history of cardiac arrest, biventricular HFrEF 45% s/p AICD, A-fib s/p LAA ligation and atrial clipping now on apixaban, severe valvulopathy s/p TVR and MVR, PAD, HTN, ESRD on HD, cirrhosis and CKD who presented to the ED with diffuse and progressively worsening abdominal pain and distention. Initial lab values showed a hemoglobin of 6.0 with a lactate of 4.0 and creatinine of 2.9 requiring 4 units of PRBCs. He then progressed into hemorrhagic shock with a blood pressure of 58/35 requiring 5 additional units of PRBCs and vasopressor support. CT angiography of the abdomen showed moderate complex ascites with a focal enhancement adjacent to the greater curvature of the stomach. He was taken for an emergent mesenteric angiogram which uncovered an 18cm GEA PSA that was subsequently coiled and embolized. He remained in the ICU for 10 days until he was downgraded and subsequently discharged home 19 days following presentation. Discussion The management of GEAPs, particularly with dimensions surpassing 10 cm, poses significant challenges. Elective repair is often recommended for asymptomatic aneurysms, while emergent treatment hinges on hemodynamic stability and the patient's comorbidities. Our case illustrates the critical implications of timely intervention in a patient with significant risk factors presenting with an 18 cm GEAP and subsequent rupture leading to hemorrhagic shock. The initial management strategy depended on rapid assessment via CT angiography, which identified the pseudoaneurysm and a significant intraperitoneal hemorrhage. Mechanical intervention was crucial in mitigating mortality risk, in this case coil embolization was pursued. Notably, our patient's significant comorbidities complicated the clinical picture, emphasizing the necessity for a multidisciplinary assessment. Conclusion The rate of rupture and mortality of GEA pseudoaneurysms can reach 80% and 100%, respectively. There are currently no screening guidelines for GEAPs due to their rarity. This case highlights the catastrophic potential of these events and the importance of awareness, recognition, and prompt intervention to prevent fatal outcomes. This abstract is funded by: None