Hematemesis from ruptured aberrant right hepatic artery aneurysm eroding through the duodenal wall.

temesis and multiple episodes of melena. He had a history of chronic lymphocytic leukemia and traumatic rupture of the spleen leading to splenectomy and splenic artery embolization 6 years earlier. Esophagogastroduodenoscopy (EGD) revealed a large submucosal mass (7 × 5 cm) with an ulcerated overlying area associated with clot in the duodenal bulb (●" Fig. 1). The ulcer was treated with epinephrine (1 :10000). A computed tomography (CT) scan of the abdomen revealed a 2.5 × 1.8-cm pseudoaneurysm from an aberrant hepatic artery off the superior mesenteric artery (●" Fig. 2) along with surrounding hematoma, causing mass effect on the duodenum; this was further confirmed with a CT angiogram (●" Fig. 3a). Coil embolization was performed with complete obliteration of the hepatic artery pseudoaneurysm (●" Fig. 3b). The patient was subsequently discharged home after 4 days of observation. The patient presented 2months later with recurrent episodes of melena. A CT angiogram showed no active extravasations. EGD revealed a long segment of coil protruding from the pylorus into the stomach, along with coffee ground materials. There was a large mound-like focal bulge at the superior aspect of the duodenal bulb, with a 6-mm defect without active bleeding, along with the protruding coil (●" Fig. 4). The patient underwent a distal gastrectomy, Billroth II gastrojejunostomy, and ligation of gastroduodenal artery. He was discharged after 5 days of observation and remained well without further episodes of bleeding after 6 months of follow-up. Hepatic artery pseudoaneurysm is a rare cause of upper gastrointestinal bleeding, and can be life-threatening [1,2]. Angiographic embolization is an effective method of treatment with a reported success rate of 80–100% [3]. However, complications from embolization are not unusual, as noted in our casewith extrusion of coils through the duodenal wall with potential for re-bleeding. Surgery may be needed in unusual circumstances for more definitive therapy.