Author(s): Abdulrahman A Rudwan, Al Badi N, Ahmad Rek Al Bakhour, Nadine Forde and Ahmed I Dhannoon Haidaran

Abstract: The most common causes of upper gastrointestinal bleed (UGIB) are peptic and posterior duodenal ulcers, usually resulting from a gastroduodenal artery (GDA) bleed. We are presenting a case of a patient who suffered from an UGIB after the commencement of apixaban to treat newly diagnosed atrial fibrillation. Despite endoscopic intervention, clear computed tomography angiography (CTA) and GDA embolisation, bleeding persisted leading to a hypovolemic shock. (Interventional Radiology images) This is a rare occurrence which led the team to request a second CTA, revealing an extravasation of contrast, indicating the persistence of bleeding which consequently led to an emergent surgery. The patient underwent an exploratory laparotomy and an ulcer was discovered during intraoperative endoscopy.The position of the ulcer was identified in the posterior-lateral duodenal wall. The persistence of bleeding despite GDA embolization suggested that the patient was most likely to be bleeding from the inferior pancreaticoduodenal artery (IPDA) or an aberrant blood vessel.Our teaching points focus on the importance of considering the pancreaticoduodenal anastomosis and other anatomical variants as sources of bleeding when managing an UGIB.

DOI: 10.22271/27081494.2024.v6.i1a.92

Pages: 15-17 | Views: 60 | Downloads: 18

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