Gastroduodenal artery pseudoaneurysm presenting as severe upper gastrointestinal bleeding in an adolescent: transarterial embolisation.

An adolescent male presented with severe upper gastrointestinal bleeding following recent non-steroidal anti-inflammatory drug use given after a neurosurgical procedure. On postoperative day 9 following this intervention, he presented to an outside emergency department with abdominal pain and constipation and was managed conservatively. On postoperative day 14, he re-presented with melena, syncope and haemodynamic instability consistent with haemorrhagic shock. Endoscopy demonstrated a large adherent clot along the posterior wall of the duodenal bulb that could not be dislodged despite extensive lavage, preventing identification of the underlying bleeding source. Haemostatic spray was applied; however, given persistent concern for an underlying vascular lesion, mesenteric angiography demonstrated a gastroduodenal artery pseudoaneurysm with active contrast extravasation. Selective transarterial coil embolisation achieved definitive haemostasis. The patient stabilised with no further bleeding. Follow-up endoscopy demonstrated ulcer healing with mild asymptomatic duodenal stenosis. This case highlights the importance of considering vascular causes in severe paediatric upper gastrointestinal bleeding and supports early angiographic evaluation when endoscopic assessment is inconclusive or definitive haemostasis is not feasible.