PMC10325565_01
Abdominal CT. (A) Axial view of abdominal CT revealed a distended abdomen (blue star) and an enhanced circular lesion around duodenal second portion (green arrow). Due to its location corresponding to gastroduodenal artery, it was more likely to be a pseudoaneurysm than a true aneurysm. (B) Axial view of abdominal CT revealed large, non-enhanced mass (white arrow). Given the patient's hemodynamic stability and absence of signs for gastrointestinal bleeding, it was likely to be an intramural hematoma. (C) Coronal view of abdominal CT showed large intramural hematoma (white arrow). (D) Coronal view of abdominal CT 3 months after transarterial embolization (TAE) revealed shrinkage of the hematoma (white arrow).
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The CT incidentally demonstrated a pseudoaneurysm with a large intramural hematoma up to 8.8 cm at the second portion of the duodenal wall, the large hematoma compress the duodenal lumen and therefore cause the distention of stomach and esophagus (Figures 1A-C). Three months after TAE, the follow-up CT image revealed shrinkage of the hematoma to 5.7 cm (Figure 1D).
Angiographic images. (A) The pseudoanuerysm (arrow) originated from the side branch of proximal gastroduodenal artery. (B) Complete embolization of the pseudoaneurysm (arrow) with NBCA.
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The angiography revealed that the pseudoaneurysm originated from the side branch of the proximal gastroduodenal artery (GDA) (Figure 2A), and embolization of both the pseudoaneurysm (Figure 2B) and feeding artery was performed using N-butyl-2-cyanoacrylate (NBCA), one kind of liquid embolic agent.
Fluoroscopic image demonstrates placement of nasoduodenal tube.
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On day 5 of admission, we placed a nasoduodenal (ND) tube under endoscopic guidance for feeding of nutritional supplements (Figure 3).