Fatal acute dissection of the right hepatic artery after appendectomy

A 53-year-old normotensive man underwent an appendectomy for suppurative appendicitis with peritonitis and Escherichia coli bacteremia. On the third postoperative day, he became severely dyspneic, developed bright red blood flow from his abdominal drains, collapsed, and died. At autopsy, a ruptured intramedial dissection of the right hepatic artery was found. Hepatic artery dissections are rare, but may be associated with abdominal operation, peritonitis, hypertension, or preexisting arterial disease.