Co esponding au ho : Rajae Bounou
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Gas oin es inal bleeding associa ed wi h a up u ed abdominal ao ic aneu ysm
e ealing Takayasu's A e i is
Rajae Bounou *, Yous a El Ki ami, Da allah Benajeh, Sidi Adil Ib ahimi and Nada Lahmidani
Depa men o Hepa o-Gas oen e ology, CHU Hassan II, Fez, Mo occo. Sidi Mohamed Ben Abdellah Uni e si y, Facul y o
Medicine, Pha macy, and Den is y o Fez.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2531-2534
Publica ion his o y: Recei ed on 21 Ma ch 2025; e ised on 27 Ap il 2025; accep ed on 30 Ap il 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1363
Abs ac
Backg ound: Takayasu a e i is is a a e sys emic asculi is a ec ing la ge a e ies, leading o s enosis o aneu ysmal
complica ions. While s eno ic lesions a e mo e common, aneu ysms can esul in li e- h ea ening e en s such as up u e
and ao oen e ic is ulas.
Case P esen a ion: We epo he case o a 41-yea -old woman admi ed o massi e uppe gas oin es inal bleeding.
Imaging e ealed an abdominal ao ic aneu ysm wi h a duodenal is ula, ul ima ely leading o he diagnosis o Takayasu
a e i is. The pa ien unde wen eme gency ao o-ao ic bypass g a ing and duodenal is ula closu e, ollowed by
immunosupp essi e he apy.
Conclusion: This case highligh s he diagnos ic challenges o Takayasu a e i is, pa icula ly in i s a e aneu ysmal
o m. Ea ly imaging and a mul idisciplina y app oach a e c ucial o imely in e en ion and imp o ed ou comes.
Keywo ds: Takayasu A e i is; Gas oin es inal Bleeding; Ao oen e ic Fis ula; Abdominal Ao ic Aneu ysms
1. In oduc ion
Takayasu a e i is is a sys emic in lamma o y disease ha p ima ily a ec s medium and la ge a e ies, pa icula ly he
ao a and i s majo b anches, including he enal, ca o id, and subcla ian a e ies. This condi ion leads o s enosis,
occlusions, o aneu ysmal degene a ion o hese essels [1].
The disease ypically begins wi h a nonspeci ic ea ly in lamma o y phase ma ked by cons i u ional symp oms such as
e e , malaise, myalgia, weigh loss, and ano exia. Mos pa ien s seek medical a en ion only du ing he "pulseless"
phase, when a e ial insu iciencies mani es as hype ension, neu ological de ici s, o uppe limb claudica ion [1].
The occu ence o uppe gas oin es inal bleeding as he ini ial p esen a ion o Takayasu a e i is is exceedingly a e,
pa icula ly when caused by he up u e o an abdominal ao ic aneu ysm wi h duodenal is uliza ion. Ao o-diges i e
is ulas hemsel es a e an uncommon cause o uppe gas oin es inal hemo hage, accoun ing o only 0.3% o cases,
ye hey a e o en li e- h ea ening [2]. Consequen ly, he combina ion o hese condi ions is excep ionally a e and
sca cely documen ed in clinical p ac ice.
We epo he case o a young woman admi ed o uppe gas oin es inal bleeding due o a up u ed abdominal ao ic
aneu ysm, which ul ima ely led o he diagnosis o p e iously un ecognized Takayasu a e i is.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2531-2534
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2. Case epo
A 41-yea -old woman was admi ed o he eme gency depa men a e expe iencing mul iple episodes o p o use
hema emesis o e he pas i e hou s. She had a his o y o hospi aliza ion ou mon hs ea lie o uppe gas oin es inal
bleeding caused by duodenal bulb ulce s, which had shown good clinical imp o emen ollowing ea men wi h p o on-
pump inhibi o s (PPIs) and e adica ion o Helicobac e pylo i.
The pa ien epo ed no addi ional symp oms apa om epigas ic pain and gas oin es inal bleeding. Physical
examina ion e ealed hypo ension wi h a blood p essu e o 80/50 mm Hg, achyca dia a 120 bea s pe minu e, and a
espi a o y a e o 20 b ea hs pe minu e. Abdominal examina ion showed no abno mali ies.
Labo a o y es s indica ed a low hemoglobin le el o 7 g/dL, while o he pa ame e s we e wi hin no mal limi s. The
pa ien was admi ed o he in ensi e ca e uni , whe e she was s abilized h ough luid esusci a ion and blood
ans usion.
Following s abiliza ion, uppe Gas oin es inal Endoscopy was pe o med, e ealing b igh ed blood o igina ing om
he hi d po ion o he duodenum. Fu he e alua ion wi h an abdominal CT angiog aphy demons a ed in lamma o y
ao i is complica ed by wo pa ially h ombosed pseudoaneu ysms o he in a enal abdominal ao a. The i s
pseudoaneu ysm was loca ed nea he o igin o he igh enal a e y, while he second was si ua ed 18 mm dis al o i
and exhibi ed a mic o is ula connec ing o he lumen o he hi d po ion o he duodenum.
Figu e 1 CT images showing in lamma o y ao i is complica ed by in a enal pseudoaneu ysms, one o which has
o med a is ula wi h he duodenum
U gen p eope a i e assessmen s we e ca ied ou , and a e uling ou con aindica ions, he pa ien unde wen ao o-
ao ic bypass g a ing along wi h closu e o he duodenal is ula.
Pos ope a i ely, she was ans e ed o he in e nal medicine depa men o u he e alua ion.
A ches CT scan e ealed aneu ysmal dila ion o he ho acic ao a, pa icula ly a he ao ic a ch and descending ao a,
wi h i egula hickened walls and ulce a ions, con i ming a diagnosis o Takayasu a e i is. She was ea ed wi h
co icos e oid boluses, ollowed by h ee cou ses o Endoxan and me ho exa e om he second cou se onwa d.
The clinical cou se was ma ked by signi ican imp o emen unde ea men , wi h esolu ion o pain and no ecu ence
o bleeding du ing a 12-mon h ollow-up.
3. Discussion
An ao oen e ic is ula (AEF) is a di ec communica ion be ween he ao a and he gas oin es inal ac . I can be
classi ied as p ima y o seconda y. Seconda y ao oen e ic is ulas occu in pa ien s who ha e p e iously unde gone
ao ic p os he ic econs uc ion and a e caused by e osion o he ao ic p os hesis in o he gas oin es inal ac . They
a e en imes mo e common han p ima y ao oen e ic is ulas [3].
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P ima y ao oen e ic is ulas a e ypically associa ed wi h spon aneous up u e o he expanding ao a in o a closely
adhe en po ion o he gas oin es inal ac . This can lead o gas oin es inal bleeding, o en o signi ican olume,
h ea ening he pa ien 's li e [3].
The majo i y o p ima y ao oen e ic is ulas esul om he expansion o abdominal ao ic aneu ysms (AAA), leading
o ch onic mechanical comp ession o he gas oin es inal ac . This comp ession causes ib o ic changes and
in lamma o y des uc ion. The hi d and ou h po ions o he duodenum a e he mos commonly a ec ed, accoun ing
o 80% o AEF cases [3]. The eason o his high incidence o up u e in o he hi d po ion o he duodenum is well
explained by he combina ion o ana omicomechanical ela ions. The hi d po ion o he duodenum is ela i ely ixed
because o i s e ope i oneal posi ion, i s ela ion o he supe io mesen e ic a e y, ligamen o T ei z, ao ic wall, and
he e eb al column [4].
The clinical p esen a ion, which includes he classic iad — gas oin es inal bleeding, abdominal pain, and pulsa ing
abdominal mass — occu s in only 25% o p ima y ao oen e ic is ula cases [5].
Uppe gas oin es inal endoscopy is he p ima y examina ion ecommended in cases o gas oin es inal bleeding o
ob ain aluable diagnos ic in o ma ion in hemodynamically s able pa ien s. Howe e , i a ely p o ides con i ma o y
e idence o a p ima y ao o-duodenal is ula, wi h a de ec ion a e o 25%, as s able pa ien s o en do no p esen wi h
ac i e bleeding [6, 7]. Howe e , al hough i does no always allow o he diagnosis o an ao o-duodenal is ula,
endoscopy helps guide u he in es iga ions. In he case we desc ibe, he p esence o ac i e bleeding in he duodenum
led us o pe o m an abdominal CT angiog aphy.
CT angiog aphy o he ao a can de e mine he size, loca ion, and deg ee o calci ica ion o an abdominal ao ic
aneu ysm, making i a aluable diagnos ic ool o ao o-duodenal is ulas, wi h a sensi i i y anging om 40% o 90%
and a speci ici y o 33% o 100%. The loss o he aneu ysmal wall, he p esence o ai in he ao ic wall, e ope i oneum,
o h ombus, as well as ocal hickening o he in es inal wall wi h des uc ion o he a plane be ween he aneu ysm
and duodenum, o he p esence o con as in he gas oin es inal ac , s ongly sugges an ao o-duodenal is ula in
he CT indings [6, 8, 9].
Howe e , ao og aphy showing con as ex a asa ion in o he in es ine was posi i e in only 26% o cases [6].
The diagnosis o a p ima y ao o-duodenal is ula emains di icul . Only 33% o 50% o ao o-en e ic is ulas a e
diagnosed p eope a i ely [10].
The he apeu ic op ions o p ima y ao o-duodenal is ula include open su ge y and endo ascula epai [3]. I le
un ea ed o misdiagnosed, he condi ion ca ies a 100% mo ali y a e. Endo ascula ao ic epai (EVAR) may se e
as a "b idge" he apy in hemodynamically uns able pa ien s, p o iding empo a y s abiliza ion and allowing o
subsequen de ini i e en e ic epai . This app oach can imp o e ou comes, pa icula ly when open su ge y is
challenging o con aindica ed [3].
The p ima y cause o abdominal ao ic aneu ysms is a he oscle osis, bu hey can also esul om in ec ions, auma,
o in lamma o y a e i ides like Takayasu a e i is [11]. This la ge- essel asculi is p edominan ly a ec s women unde
40 yea s o age, wi h an incidence o 1.2-2.6 cases pe million people annually [3]. While 90% o cases in ol e s enosis,
up o 25% de elop aneu ysms, p ima ily in he ao a, subcla ian, b achiocephalic, and ca o id a e ies [3]. The eal
incidence o up u e o ei he he abdominal o ho acic ao ic aneu ysms is no known, bu seems o be low [12].
Medical ea men elies on an i-in lamma o y and immunosupp essi e agen s.Co icos e oids emain he co ne s one
du ing ac i e phases, o en combined wi h o he immunosupp essi e he apies [12].
4. Conclusion
Takayasu a e i is is a a e bu se ious asculi is a ec ing la ge a e ies, leading o s enosis o aneu ysmal
complica ions. Al hough less common, aneu ysms can be li e- h ea ening, equi ing p omp imaging o diagnosis.
Su gical in e en ion and immunosupp essi e he apy a e key o managemen , wi h endo ascula epai as an op ion
in uns able cases. Ea ly diagnosis and a mul idisciplina y app oach a e c ucial o be e ou comes.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2531-2534
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Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
The au ho s decla e ha hey ha e no compe ing in e es .
S a emen o in o med consen
In o med consen was ob ained om all indi idual pa icipan s included in he s udy.
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