title: Accessory left gastric artery aneurysms in granulomatosis with polyangiitis: a case report and literature review.
abstract: Aneurysm formation is a potential complication of granulomatosis with polyangiitis (GPA), previously known as Wegener's granulomatosis. It is a very rare complication, but immediate diagnosis and therapy should be performed because an aneurysm can be life-threatening if it ruptures. An accessory left gastric artery (ALGA) is also a rare variant gastric artery that may obtain its blood supply from the left hepatic artery and left gastric artery. We herein describe a 57-year-old Japanese man who was diagnosed with GPA complicated by aneurysm rupture in an ALGA. Emergency surgery was performed after failure of arterial coil embolization to interrupt blood flow in the ALGA. The patient underwent partial resection of the lesser omentum, which contained all aneurysms. During partial resection of the lesser omentum, both the left gastric artery and ALGA were ligated because they were thought to be feeders of the aneurysms. Postoperative recovery was uneventful; no bleeding or recurrence of the aneurysms occurred. Immediate diagnosis and therapy should be performed for patients with GPA with symptoms of vascular ischemia or aortitis. Endovascular intervention is the first-choice therapy especially for hemodynamically stable patients with ruptured aneurysms or aneurysms located on variant arteries, which may have multiple blood supplies. In the present case, although endovascular treatment failed, the approach described herein was helpful during open surgery.
authors.affiliation: Department of Surgery, Tosei General Hospital, Seto, Japan.
authors.forename: Toshihide
authors.initials: T
authors.lastname: Tomosugi
authors.affiliation: Department of Surgery, Tosei General Hospital, Seto, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Department of Surgery, Tosei General Hospital, Seto, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kawase
authors.affiliation: Department of Surgery, Tosei General Hospital, Seto, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Surgery, Tosei General Hospital, Seto, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Hayashi
authors.affiliation: Department of Surgery, Tosei General Hospital, Seto, Japan.
authors.forename: Takefumi
authors.initials: T
authors.lastname: Sugiyama
authors.affiliation: Department of Surgery, Tosei General Hospital, Seto, Japan.
authors.forename: Mitsuya
authors.initials: M
authors.lastname: Shimizu
authors.affiliation: Department of Surgery, Tosei General Hospital, Seto, Japan.
authors.forename: Michita
authors.initials: M
authors.lastname: Shoka
authors.affiliation: Department of Surgery, Tosei General Hospital, Seto, Japan.
authors.forename: Kohichi
authors.initials: K
authors.lastname: Sawaki
authors.affiliation: Department of Surgery, Tosei General Hospital, Seto, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Onishi
authors.affiliation: Department of Surgery, Tosei General Hospital, Seto, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Hayashi
authors.affiliation: Department of Surgery, Tosei General Hospital, Seto, Japan.
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Matsushita
authors.affiliation: Department of Surgery, Tosei General Hospital, Seto, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Okochi
mesh_terms: D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D000077426:Gastric Artery / Q000473:pathology*; D014890:Granulomatosis with Polyangiitis / Q000150:complications*; D006801:Humans; D008297:Male; D011184:Postoperative Period
keywords: accessory left gastric artery; aneurysm; granulomatosis with polyangiitis