# Perforated Gastric Ulcer With GI Bleeding Secondary to Cystic Artery Pseudoaneurysm

## TL;DR

An elderly woman with a perforated gastric ulcer and GI bleeding was found to have a cystic artery pseudoaneurysm, managed with imaging and embolization.

## Contribution

Highlights a rare cause of upper GI bleeding and the importance of imaging in guiding treatment.

## Key findings

- A cystic artery pseudoaneurysm was identified as the source of upper GI bleeding in an elderly patient.
- Conservative treatment combined with embolization successfully managed the condition without surgery.
- Imaging was critical in diagnosing a contained perforation and guiding intervention.

## Abstract

This case study presents an 87-year-old female patient with a history of chronic abdominal pain and NSAID use who was admitted with symptoms of hematemesis and melena, indicative of upper gastrointestinal bleeding. Upon examination, she was found to be hemodynamically stable but exhibited signs of moderate protein-calorie malnutrition. Imaging studies, including a multiphasic CT angiogram, revealed a contained rupture in the distal stomach, and a cystic artery pseudoaneurysm measuring 4.2 mm. Despite the presence of a perforated ulcer, there was no significant pneumoperitoneum or hemoperitoneum, leading to a diagnosis of contained perforation. The management plan included conservative treatment with IV antibiotics, proton pump inhibitors, and monitoring of hemodynamic status. On the third day of admission, the decision was made to embolize the cystic artery, as the risk of gallbladder ischemia was deemed low. This case underscores the critical need for prompt diagnosis and intervention in patients presenting with upper GI bleeding, particularly in the elderly, where the mortality rate can be significantly high. The findings emphasize the importance of imaging in localizing the source of bleeding and guiding appropriate management strategies.