A 48-year-old man was admitted to the ICU for hematemesis. Several attempts at endoscopic intervention failed to control the bleeding from a visible, pumping vessel on the posterior wall of the duodenal bulb. The patient was taken to the operating room where the duodenal bulb, pylorus and distal antrum were opened between stay sutures.
The gastric blood supply from the celiac trunk is shown. The lesser curve is supplied by the right gastric artery from the hepatic, and the left gastric, usually a branch of the celiac trunk. The greater curve is supplied by the right and left gastroepiploic arteries from the gastroduodenal and splenic respectively, and by the short gastrics from the splenic.
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The gastroduodenal artery branches from the common hepatic artery and passes between the duodenal bulb and head of the pancreas, where it is vulnerable to erosion by a deeply penetrating posterior ulcer.
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