A Bleeding Crisis Unveiled. Innovative Endoscopic Resolution of a Gastric Pseudoaneurysm. Gastric pseudoaneurysms are rare but potentially life-threatening causes of upper gastrointestinal bleeding. Prompt diagnosis and intervention are crucial. This case report highlights the diagnostic and therapeutic approach in managing a gastric pseudoaneurysm presenting with hematemesis in an elderly patient. An 84-year-old male with a history of hypertension and osteoarthritis presented with massive hematemesis and hemodynamic instability. Initial resuscitation included transfusion of blood products and endotracheal intubation to protect the airway. A CT scan of the abdomen and pelvis with contrast identified a pseudoaneurysm along the lesser curvature of the stomach. Subsequent angiography failed to visualize the pseudoaneurysm leading to an endoscopic evaluation. Endoscopy revealed a 20-millimeter oozing crated gastric ulcer with an adherent clot in the cardia. Endoscopic ultrasound, EUS, identified a 30 by 40 millimeter hypoechoic heterogeneous intramural lesion consistent with a pseudoaneurysm from the left gastric artery. Doppler studies confirmed active bleeding. Interventional management included the deployment of three embolization coils and injection of 2 milliliters cyanoacrylate via a 19-gauge needle under sonographic and Doppler guidance. The patient showed clinical improvement and was successfully extubated. A follow-up CTA confirmed resolution of the pseudoaneurysm. This case highlights the importance of a multidisciplinary approach in managing gastric pseudoaneurysms. EUS-guided intervention with coil embolization and topical hemostatic agents can be effective in achieving hemostasis. Prompt and precise endoscopic and radiologic evaluation are essential for successful outcomes in similar presentations.

gastric pseudoaneurysm

EUS-guided intervention

multidisciplinary approach

embolization

upper gastrointestinal bleeding