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Hepatic artery aneurysm
R B Lal1, J A Strohl, S Piazza
1University of Illinois.
Insights
A hepatic artery aneurysm complicated a gallbladder surgery, causing bile duct obstruction. Prompt treatment involving drainage and emergency surgery led to a full recovery, highlighting the importance of timely intervention for this rare condition.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Hepatobiliary Surgery
Background:
- Hepatic artery aneurysms are rare but life-threatening vascular anomalies.
- They can present with vague symptoms or catastrophic hemorrhage.
- Acute acalculous cholecystitis can sometimes mask or coexist with hepatic artery aneurysms.
Observation:
- A 67-year-old male presented with epigastric pain, leading to cholecystectomy for acute acalculous cholecystitis.
- Intraoperative exploration revealed a large hepatic artery aneurysm.
- Postoperatively, the patient developed jaundice, ascending cholangitis, and common bile duct obstruction due to the aneurysm.
Findings:
- The patient's obstructive jaundice and cholangitis resolved dramatically after percutaneous transhepatic drainage.
- An emergency aneurysm resection was successfully performed.
- The patient recovered well and remained asymptomatic at 8-month follow-up.
Implications:
- Hepatic artery aneurysms require prompt diagnosis and management due to high mortality.
- Surgical repair (aneurysmorrhaphy or reconstruction) is the primary treatment.
- Embolization serves as a viable alternative for high-risk or surgically unfit patients.
Abstract:
A 67-year-old man presented with epigastric pain and underwent cholecystectomy for acute acalculus cholecystitis. Exploration revealed a large aneurysm in the hepatic artery. One week later, the patient developed jaundice, ascending cholangitis and common bile duct obstruction. He was treated with percutaneous transhepatic drainage with dramatic improvement, then underwent an emergency aneurysm resection operation. He is now well, 8 months postoperatively. Due to the high mortality rate associated with hepatic artery aneurysm, treatment is primarily surgical with aneurysmorrhaphy or direct arterial reconstruction utilizing either autogenous saphenous vein or prosthetic grafts. For inaccessible aneurysms or when patients are unfit to withstand surgery, embolization is a useful alternative.