Gastrointestinal bleeding secondary to duodenal vascular anomaly due to median arcuate ligament syndrome

Abstract

We present the case of a 52-year-old woman with a history of CADASIL syndrome and dependence for basic activities of daily living who was admitted to the hospital due to asthenia, dizziness and anemia. During hospitalization imaging tests were performed, detecting stenosis of the celiac trunk secondary to compression by the median arcuate ligament, as well as dilatation of the pancreaticoduodenal arcades and aneurysm of a submucosal pyloroduodenal artery. Subsequently, she started with melena and hemodynamic instability, for which reason oral endoscopy was performed with the finding of a visible vessel in the anterior wall of the duodenal bulb. Hemostatic treatment was applied and the clinical-radiological evolution was favorable, dismissing other more invasive options due to the patient's fragility.

Keywords: gastrointestinal bleeding, median arcuate ligament syndrome, aneurysm.