SHM Converge Scientific Abstract ePoster Gallery-Gastroduodenal Artery Pseudoaneurysm Presenting as Common Bile Duct Obstruction

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This case describes a rare cause of obstructive jaundice: a gastroduodenal artery (GDA) pseudoaneurysm compressing the common bile duct. A 69-year-old man with metastatic prostate cancer on chemotherapy presented with three days of fever, tachycardia, and right upper quadrant tenderness. Laboratory tests showed leukocytosis, elevated alkaline phosphatase, and hyperbilirubinemia, suggesting cholestatic transaminitis. Initial infectious studies, including chest X-ray, blood cultures, and urine cultures, were unrevealing, and he was started empirically on cefepime for sepsis of unclear source.<br /><br />Abdominal CT imaging identified a 5.3 x 5.4 cm GDA aneurysm causing common bile duct compression and dilation of the hepatic ductal system. Because visceral artery aneurysms carry a significant risk of rupture and bleeding, vascular surgery recommended urgent treatment. The patient underwent endovascular stent placement of the GDA arising from the hepatic artery and coil embolization of feeder branches from the superior mesenteric artery. Additional evaluation for an infectious source, including transthoracic echocardiography, was negative. Given concern for a mycotic aneurysm, he was discharged on intravenous ceftriaxone to complete a four-week course.<br /><br />The discussion emphasizes that GDA aneurysms are rare, accounting for about 1.5% of all visceral artery aneurysms. They may be true aneurysms or pseudoaneurysms, the latter often related to inflammation, prior procedures, pancreatitis, or infection. Because rupture risk is high, endovascular intervention should not be delayed. The case highlights the importance of abdominal imaging in patients with cholestatic liver test abnormalities or obstructive jaundice to detect uncommon but dangerous causes such as visceral aneurysms.

Asset Subtitle

Noor Ul Ain

Meta Tag

Author List Aleesha Kainat, Jonathan Arnold, Khushboo Singh, Noor Ul Ain

Category Clinical Vignettes

Concept Gastroduodenal Artery Pseudoaneurysm

Concept Common Bile Duct Obstruction

Concept Obstructive jaundice

Concept Cholestatic Transaminitis

Concept Visceral Artery Aneurysm

Distinguished Non-Finalist

Presenter Organization Department of General Internal Medicine, University of Pittsburgh Medical Center, McKeesport

Presenting Author Noor Ul Ain

Track Adult

Keywords

obstructive jaundice

gastroduodenal artery pseudoaneurysm

common bile duct compression

visceral artery aneurysm

cholestatic transaminitis

endovascular stent placement

coil embolization

mycotic aneurysm

abdominal CT imaging

hepatic ductal dilation

Gastroduodenal Artery Pseudoaneurysm

Common Bile Duct Obstruction

Obstructive jaundice

Cholestatic Transaminitis

Visceral Artery Aneurysm