Spectrum of Atypical Vascular Pathologies Mimicking Duodenal Submucosal Tumor and Directly Bleeding into Duodenal Lumen: A Case Series Study with Management by Interventional Radiology

Abstract

Gastrointestinal (GI) bleeding is a life-threatening medical condition and requires a multidisciplinary approach for proper diagnosis and management. Various vascular pathologies in and around the duodenum can lead to bleeding into the duodenum either directly or through the bile duct or pancreatic duct, and the patients present with melena or hematemesis. Sometimes, these lesions present as a submucosal tumor with active bleeding or present like a bleeding duodenal ulcer. These cases must be investigated thoroughly before any endoscopic interventions; otherwise, patient may land up in life-threatening situations. Radiology plays an important role in both diagnosing and treating these vascular lesions. Here, we have presented a few cases where the vascular pathologies mimicking duodenal submucosal tumors caused direct bleeding into the duodenum.

Keywords

duodenal bleed - duodenal submucosal tumor - pseudoaneurysm - case series

Ethics Approval and Consent to Participate

The procedure described was in accordance with the institutional ethical guidelines and conform to the World Medicine Association declaration of Helsinki regarding the ethical principles for medical research involving human subjects.

Consent for Publication

Written informed consent was obtained from the patient and the patient's relatives for publication of the article.

Publication History

Article published online:
13 January 2025

• References

• 1 Wilkins T, Khan N, Nabh A, Schade RR. Diagnosis and management of upper gastrointestinal bleeding. Am Fam Physician 2012; 85 (05) 469-476
• 2 Krishna Kandarpa. John E. Aruny. Handbook of Interventional Radiologic Procedures. (2002) ISBN: 9780781723589
• 3 Motoo Y, Okai T, Ohta H. et al. Endoscopic ultrasonography in the diagnosis of extraluminal compressions mimicking gastric submucosal tumors. Endoscopy 1994; 26 (02) 239-242
• 4 Okano A, Takakuwa H, Matsubayashi Y. Aortoduodenal fistula resembling a submucosal tumor due to penetration of abdominal aortic aneurysm. Intern Med 2005; 44 (08) 904-905
• 5 al-Jeroudi A, Belli AM, Shorvon PJ. False aneurysm of the pancreaticoduodenal artery complicating therapeutic endoscopic retrograde cholangiopancreatography. Br J Radiol 2001; 74 (880) 375-377
• 6 Hügel HE, Oser W, Bodner E. Aneurysm of the proper hepatic artery as a rare source of upper gastrointestinal bleeding. Gastrointest Radiol 1986; 11 (02) 158-160
• 7 Aboujaoude M, Noel B, Beaudoin M, Ghattas G, Lalonde L, Oliva VL. The Bao Bui. Pseudoaneurysm of the proper hepatic artery with duodenal fistula appearing as a late complication of blunt abdominal trauma. J Trauma 1996; 40 (01) 123-125
• 8 Sjödahl R, Wetterfors J. Lysolecithin and lecithin in the gallbladder wall and bile; their possible roles in the pathogenesis of acute cholecystitis. Scand J Gastroenterol 1974; 9 (06) 519-525
• 9 Pickhardt PJ, Bhalla S, Balfe DM. Acquired gastrointestinal fistulas: classification, etiologies, and imaging evaluation. Radiology 2002; 224 (01) 9-23
• 10 Horton KM, Smith C, Fishman EK. MDCT and 3D CT angiography of splanchnic artery aneurysms. AJR Am J Roentgenol 2007; 189 (03) 641-647
• 11 Jesinger RA, Thoreson AA, Lamba R. Abdominal and pelvic aneurysms and pseudoaneurysms: imaging review with clinical, radiologic, and treatment correlation. Radiographics 2013; 33 (03) E71-E96