A patient presents with hematemesis and melena. Urgent endoscopy reveals a duodenal ulcer with active spurting arterial bleeding (Forrest grade Ia). Endoscopic hemostasis is achieved with dual therapy. Which vessel is most commonly responsible for significant bleeding from a posterior duodenal ulcer?

• A Superior mesenteric artery
• B Right gastroepiploic artery
• C Inferior pancreaticoduodenal artery
• D Gastroduodenal artery (GDA) ✓

Explanation

Posterior duodenal ulcers erode into the gastroduodenal artery (GDA), which runs in the groove between the posterior first part of the duodenum and the head of the pancreas. This produces massive, life-threatening upper GI hemorrhage. If endoscopic hemostasis fails (re-bleeding occurs in ~15-20%), emergency surgery involves under-running the bleeding vessel with three-point suture ligation of the GDA proximally and distally plus the transverse pancreatic branch, without formal resection in the acute setting.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.