Ruptured hepatic artery aneurysm precipitated by gangrenous perforated appendicitis: a case report
Alec F Snow1, Milena Vannahme2, Laura Kettley3
1CT1 General Surgery, Frenchay Hospital, Bristol, UK alec.snow@nhs.net.
Journal of Surgical Case Reports
|May 14, 2016
Summary
Sudden rupture of hepatic artery aneurysms can occur, especially when linked to abdominal sepsis. Inflammation may activate matrix metalloproteinases (MMPs), degrading collagen and causing fatal aneurysm rupture.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Pathology
Background:
- Hepatic artery aneurysms (HAAs) are rare but carry a high risk of rupture and mortality.
- Repair is recommended for aneurysms exceeding 2 cm in diameter.
- Visceral artery aneurysms are uncommon but significant vascular conditions.
Observation:
- A case of sudden hepatic artery aneurysm rupture is presented following perforated gangrenous appendicitis.
- The patient presented with symptoms of appendicitis, which progressed to sepsis and peritonitis.
- Rupture occurred acutely after the initial presentation of appendicitis.
Findings:
- Matrix metalloproteinases (MMPs) degrade elastin and collagen, contributing to aneurysm expansion and rupture.
- Sepsis and peritonitis are known to upregulate MMP activity.
- The study suggests inflammation from sepsis/peritonitis activated MMPs, leading to collagen degradation and HAA rupture.
Implications:
- This case highlights a potential mechanism linking abdominal sepsis and HAA rupture.
- Understanding MMP activation in inflammatory conditions is crucial for managing visceral artery aneurysms.
- Early recognition and management of appendicitis may be critical in preventing secondary vascular events.
