case_images: PMC10550486_01
case_images: Axial contrast-enhanced computed tomographic images reveal a pseudoaneurysm at the pancreatic tail-omental bursa region adjacent to the gastric wall, which might be the cause of the bleeding (white arrow: pancreatic pseudocyst; black arrow: pseudoaneurysm lumen filling with contrast; red dashed arrow: thrombus).
case_images: CRICC2023-7888990.001.jpg
case_images: PMC10550486_01_CRICC2023-7888990.001.jpg
case_images: fig1
case_images: The second endoscopy also revealed a small, shallow duodenal ulcer and a large amount of blackish-red blood in the stomach; therefore, computed tomography (CT) angiography was promptly performed as the next step (Figures 1-3).
case_images: Axial contrast-enhanced computed tomographic images demonstrate a second pseudoaneurysm arising from the gastroduodenal artery, suggesting recent and ongoing bleeding (white arrow: pancreatic pseudocyst; black arrow: pseudoaneurysm filling with contrast; red dashed arrow: thrombus).
case_images: CRICC2023-7888990.002.jpg
case_images: PMC10550486_01_CRICC2023-7888990.002.jpg
case_images: fig2
case_images: The second endoscopy also revealed a small, shallow duodenal ulcer and a large amount of blackish-red blood in the stomach; therefore, computed tomography (CT) angiography was promptly performed as the next step (Figures 1-3).
case_images: Coronal contrast-enhanced computed tomographic images reveal two pseudoaneurysms (black arrows: pseudoaneurysm filling with contrast).
case_images: CRICC2023-7888990.003.jpg
case_images: PMC10550486_01_CRICC2023-7888990.003.jpg
case_images: fig3
case_images: The second endoscopy also revealed a small, shallow duodenal ulcer and a large amount of blackish-red blood in the stomach; therefore, computed tomography (CT) angiography was promptly performed as the next step (Figures 1-3).
case_images: Assessing the vascular supply of the pseudoaneurysms by angiography followed by coil embolization. (a) A pseudoaneurysm arising from the gastroduodenal artery. (b) Coil embolization of the target artery and the pseudoaneurysmal sac. (c) A pseudoaneurysm arising from the short gastric artery. (d) Successful coil embolization of the target arteries and both pseudoaneurysm sacs.
case_images: CRICC2023-7888990.004.jpg
case_images: PMC10550486_01_CRICC2023-7888990.004.jpg
case_images: fig4
case_images: After consulting with the interventional radiology and gastroenterology teams, the patient was referred to the interventional radiology department for emergency angiography with intervention (see Figure 4).