Gastrointestinal bleeding from an arterial-enteric fistula postcoil embolisation of GDA pseudoaneurysm after pancreatico-duodenectomy

Postoperative bleeding from a gastroduodenal artery (GDA) pseudoaneurysm is a serious and potentially life-threatening complication following pancreatoduodenectomy. While it can often be controlled with timely intervention, it carries the risk of rare, challenging secondary complications. We discuss in this report an elderly male who underwent a pancreatico-duodenectomy. Fourteen months postsurgery, he presented with bleeding and abdominal pain. Following an immediate CT angiogram, endovascular coil embolisation of the GDA pseudoaneurysm, along with the placement of a covered stent in the common hepatic artery (CHA), was performed. The bleeding had stopped. Unfortunately, 2 months later, he endured another gastrointestinal bleed. An Esophagogastroduodenoscopy and a CTA were done, which showed a clot and confirmed the coils in the afferent limb of the jejunum at the pancreato-jejunal anastomosis site. An endoscopic attempt at retrieval was unsuccessful, and the coils eventually egressed spontaneously. This case underscores the clinical relevance of pseudoaneurysms in postpancreatico-duodenectomy patients and highlights the potential complications associated with interventions. .