SHM Converge Scientific Abstract ePoster Gallery-The Hidden Culprit: A Duplicate Gastroduodenal Artery Triggering Recurrent Duodenal Ulcer Bleeds

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This case report describes life-threatening upper gastrointestinal bleeding from a posterior duodenal ulcer in a 63-year-old man with recent NSAID use and concurrent pulmonary embolism requiring anticoagulation. He presented with melena, coffee-ground emesis, tachycardia, anemia, elevated lactate, and leukocytosis. Because anticoagulation was needed but unsafe in the setting of active GI bleeding, he received IV pantoprazole, blood transfusions, and an IVC filter.<br /><br />Upper endoscopy showed a 22 mm non-bleeding cratered duodenal bulb ulcer. Given the high risk of rebleeding and the need for future anticoagulation, prophylactic gastroduodenal artery (GDA) embolization was performed. Angiography revealed a rare duplicated GDA with communication to the superior mesenteric artery. Both the medial and lateral branches were embolized with coils.<br /><br />Despite embolization, the patient had persistent melena, though repeat endoscopy showed no active bleeding. CTA later demonstrated the duodenal ulcer and a segmental splenic infarct. Anticoagulation was held for one week, then restarted after a repeat biopsy confirmed a benign ulcer. He was discharged on warfarin with close INR monitoring and remained clinically stable at 1- and 6-month follow-up.<br /><br />The report emphasizes that duplicated GDA is a rare vascular variant that can increase the risk of recurrent or persistent bleeding from duodenal ulcers. Standard coil embolization may fail if all feeding branches are not identified. Therefore, detailed angiographic mapping and early interventional radiology involvement are essential in recurrent or high-risk duodenal ulcer bleeding cases.

Asset Subtitle

Gunjan Malhotra

Meta Tag

Author List Aaysha Kapila, Anish Chopra, Ankur Singla, Ankuriti Singla, Gunjan Malhotra, Hargun Malhotra, Kailash Bajaj, Nihar Vavaliya

Category Clinical Vignettes

Concept Posterior Duodenal Ulcer Bleeding

Concept Peptic Ulcer Upper Gastrointestinal Bleeding

Concept Embolization

Concept Gastroduodenal Artery

Concept Angiographic Mapping

Distinguished Non-Finalist

Presenter Organization Northwest Health-Porter, Valparaiso, IN, USA

Presenting Author Gunjan Malhotra

Track Adult

Keywords

duodenal ulcer

upper gastrointestinal bleeding

NSAID use

anticoagulation

gastroduodenal artery embolization

duplicated GDA

melena

pulmonary embolism

IVC filter

angiography

Posterior Duodenal Ulcer Bleeding

Peptic Ulcer Upper Gastrointestinal Bleeding

Embolization

Gastroduodenal Artery

Angiographic Mapping