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Hepatopancreatobiliary
Inside view
What DSA can do: rethinking from fatal intra-abdominal haemorrhage after EUS-FNA for a large abdominal mass
  1. Jia Xu1,
  2. Lisha Jing2,
  3. Yabing Wang3,
  4. Zheng Wang4,
  5. Jin Bian5,
  6. Zhiwei Wang1,
  7. Xuan Wang1,
  8. Kun He6
  1. 1Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
  2. 2Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
  3. 3Department of Endocrinology, Beijing Friendship Hospital, Capital Medical College, Beijing, People's Republic of China
  4. 4Department of Pathology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, People's Republic of China
  5. 5Department of Liver Surgery, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, People's Republic of China
  6. 6Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
  1. Correspondence to Kun He; hk6290418{at}163.com; Dr Xuan Wang; wxpumc{at}163.com

https://doi.org/10.1136/flgastro-2024-102963

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    Case presentation

    A 51-year-old man was admitted due to 4 month severe epigastric pain, with a history of untreated maternal–infant transmitted hepatitis B. Laboratory tests showed normal blood count and liver function, elevated alpha-fetoprotein (AFP) of 205 ng/mL, HBsAg (+), HBcAb (+), HBeAg (−), HBeAb (−) and an HBV-DNA level of 5143 IU/mL. Ultrasound and MRI revealed a large mass in the right upper abdomen, with suspicion of gastrointestinal stromal tumour (GIST) (figure 1A). On referral to our hospital, enhanced abdominal CT showed a 10.2 cm × 8.8 cm mass with heterogeneous enhancement and an inconspicuous fast-in/fast-out pattern, suggesting origin from antrum, compression of right liver lobe (figure 1B,C) and blood supply from gastro-duodenal artery (figure 1D). Endoscopic ultrasonography (EUS) revealed an unclear boundary between the mass and the antrum, with smooth mucosa (figure 2). EUS-guided fine needle aspiration (EUS-FNA) was taken as PET-CT showed hypermetabolism, but the patient developed severe abdominal pain, hypotension and a decrease in haemoglobin immediately after operation, with CT angiography indicating contrast extravasation in the mass and …

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    Footnotes

    • JX, LJ and YW contributed equally.

    • Contributors JX and LJ wrote the manuscript. YW, ZW, JB, ZWW reviewed the literature and provided critical revision of the manuscript. KH and XW provided overall supervision of the manuscript. All authors approved the final version of the manuscript to be published. KH is the guarantor.

    • Funding This work was supported by National High Level Hospital Clinical Research Funding [2022-PUMCH-B-069].

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.