An enigmatic enteroscopic image in a patient with upper gastrointestinal bleeding

Fig. 1. Two enteroscopic images of an enigmatic amorphous tissue of uncertain origin, with underlying oozing bleeding, at the site of the hepatico-jejunal anastomosis.

Fig. 2. (A) Pre-procedural ultrasonography documenting a voluminous pseudoaneurysm of the hepatic artery propria with the pathognomonic “Yin and Yang sign”, determined by the typical inflow and outflow of blood as a swirling motion in the sac through the neck. (B) Arteriography confirming the presence of a pseudoaneurysm of the hepatic artery, corresponding in shape, size, and location with the structure visualized at anterograde double-balloon enteroscopy. (C) Arteriography with embolization of the gastroduodenal artery. (D) Arteriography with stenting of the hepatic artery and subsequent exclusion of the pseudoaneurysm.

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