Overview
Gastroepiploic arterial aneurysms (GEAA) are rare vascular abnormalities with a significant risk of rupture and high mortality if not promptly addressed 1. They are often discovered incidentally or after rupture, necessitating urgent intervention 13.Diagnosis
Clinical Presentation: Acute epigastric pain, hemodynamic stability or instability 1.
Imaging: Abdominal ultrasonography and computed tomography angiography (angio-CT) to identify nodules and confirm aneurysm presence 1.
Hemodynamic Status: Assessment crucial for determining initial management approach (surgical vs. endovascular) 1.Management
Hemodynamically Stable Patients: Endovascular embolization as initial approach 1.
Failed Endovascular Approach: Laparoscopic resection considered effective 1.
Hemodynamically Unstable Patients: Emergency open surgical resection recommended 14.Special Populations
Elderly: Laparoscopic resection feasible and successful in elderly patients, as demonstrated in an 83-year-old case 1.Key Recommendations
For hemodynamically stable patients with GEAA, attempt endovascular embolization initially (Evidence: Moderate 1).
In cases where endovascular treatment fails, laparoscopic resection is a viable and effective alternative (Evidence: Weak 1).
Hemodynamically unstable patients require immediate open surgical intervention to manage rupture risk (Evidence: Expert opinion 4).References
1 Bertolucci A, Tartaglia D, Cobuccio L, Galatioto C, Chiarugi M. Laparoscopic resection of multiple aneurysms of the gastroepiploic arterial arcade. Surgical endoscopy 2018. link