Duodenal Ulceration into the Cystic Artery with Resultant Massive Hemorrhage

Anterior duodenal ulceration with erosion into the cystic artery is an extremely rare source of upper gastrointestinal hemorrhage. Interventions that have previously been reported include open exploration with cholecystectomy, open exploration while leaving the gallbladder in situ, and angiographic management. We report a case of massive upper gastrointestinal bleeding related to duodenal ulcer penetration of the cystic artery and discuss potential management strategies.

[1]  M. Webster.  Mastery of Surgery, 4th edition , 2002 .

[2]  D. Graham,et al.  Pathogenesis and therapy of gastric and duodenal ulcer disease. , 2002, The Medical clinics of North America.

[3]  G. Germann,et al.  The value of early enteral nutrition in the prophylaxis of stress ulceration in the severely burned patient. , 1997, Burns : journal of the International Society for Burn Injuries.

[4]  M. A. Memon,et al.  Post-bulbar chronic duodenal ulcer with major upper gastrointestinal bleeding from the cystic artery. , 1995, Postgraduate medical journal.

[5]  F. Petersen,et al.  A prospective study of risk for peptic ulcer disease in Seventh-Day Adventists. , 1992, Gastroenterology.

[6]  G. Maddern,et al.  A rare cause of severe bleeding from the anterior duodenal wall: the cystic artery. , 1991, Journal of clinical gastroenterology.

[7]  A. Simpson,et al.  Duodenal ulceration into the cystic artery. , 1990, Postgraduate medical journal.

[8]  G. Cust,et al.  Changing pattern of admissions and operations for duodenal ulcer , 1989, The British journal of surgery.

[9]  D. Piper,et al.  Influence of the site of a duodenal ulcer on its mode of presentation. , 1986, Gastroenterology.

[10]  S. Hori,et al.  Gallbladder infarction following hepatic transcatheter arterial embolization. Angiographic study. , 1983, Radiology.

[11]  R. Koehler,et al.  Cystic artery hemorrhage: a complication of penetrating duodenal ulcer. , 1980, Radiology.

[12]  E. Beranbaum,et al.  Peptic Erosion of the Cystic Artery , 1972, Angiology.

[13]  B. Choi,et al.  Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization. , 1996, Radiology.

[14]  M. Sinanan,et al.  Gangrenous cholecystitis as a complication of hepatic artery embolization: case report. , 1992, Surgery.