A53-10 A Rare Case of Fatal Shock: Acute Gastroduodenal Artery Aneurysm Rupture After Recreational Amphetamine Use

Abstract Introduction Gastroduodenal artery (GDA) aneurysm rupture is a rare but life-threatening event that can be suddenly fatal in otherwise healthy patients with unrecognized vascular risk factors. The GDA arises from the common hepatic artery and is susceptible to aneurysm formation. GDA aneurysms commonly occur secondary to trauma, pancreatitis, peptic ulcer disease, or celiac artery stenosis, and are prone to rupture. We present a fatal case of an acute GDA aneurysm rupture following recreational amphetamine use complicated by intra-abdominal bleeding, abdominal compartment syndrome, and shock. Description A 56-year-old man without significant past medical history presented to the emergency room after an acute onset of abdominal pain. Upon arrival, his vital signs were within normal limits. Laboratory studies revealed a mild metabolic acidosis and a rapid decline in hemoglobin levels over 6 hours. A computed tomography scan of the abdomen and pelvis (CTAP) demonstrated a large intra-abdominal hematoma with suspected involvement of the GDA. The patient underwent emergent embolization of the affected vessel. After the procedure, the patient developed shock requiring norepinephrine and packed red blood cell transfusion. A second CTAP revealed an expanding hematoma (Figure). The patient subsequently progressed to acute kidney injury and acute liver failure due to shock. He required continuous renal replacement therapy for metabolic acidosis and hyperammonemia. A urine drug screen was positive for amphetamines. A thorough review of his outpatient and inpatient medications did not reveal any amphetamines or medications known to cause false-positive results. An extensive social history obtained from the patient’s family demonstrated behaviors consistent with amphetamine-type substance use disorder. As the patient’s clinical status decompensated from abdominal compartment syndrome, progressive bowel ischemia, and hematoma expansion, the patient’s family elected to transition his care to comfort measures. The patient subsequently died from complications of mixed hemorrhagic and distributive shock with multiple organ dysfunction syndrome. Discussion GDA aneurysm rupture is rarely described in the literature particularly in the context of amphetamine use disorder. Amphetamine use has been associated with vascular complications including cerebral hemorrhage and aortic dissection. This case supports amphetamine use as a contributing factor to GDA aneurysm development via acute and chronic vascular effects, including catecholamine-induced hypertension. The risk of acute rupture is heightened in the hyperadrenergic state of amphetamine exposure. Given that our patient did not demonstrate other predisposing factors, this case suggests that amphetamine use disorder can play a critical role in the development and rupture of a GDA aneurysm. This abstract is funded by: None