Left Hepatic Artery Pseudoaneurysm and Arteriobiliary Fistula in an Adolescent: A Case Report

Hepatic artery pseudoaneurysm is a rare but potentially life-threatening vascular condition, with risks of rupture, fistula formation, and massive hemorrhage. It most commonly occurs secondary to trauma, infection, inflammation, or iatrogenic injury. In this report, the case of a 15-year-old boy with idiopathic juvenile arthritis who presented with chronic anemia, intermittent right upper quadrant and epigastric pain, low-grade fever, and occasional vomiting for two years is reported, with repetitive attacks of pancreatitis. Ultrasound of the abdomen showed sludge in the gallbladder. Magnetic resonance cholangiopancreatography (MRCP) showed the lumen of the gallbladder with an ill-defined fluid level suggestive of a sludge ball, and a wall thickness of 3 mm. So, a laparoscopic cholecystectomy was performed on the basis of the patient's symptoms and findings. Postoperatively, after one month, the patient had symptoms of abdominal pain, melena, and a fall in hemoglobin. CT scan and selective angiography revealed a small pseudoaneurysm arising from the medial branch of the left hepatic artery with associated biliary duct dilatation, suggestive of an arteriobiliary fistula. The patient underwent transcatheter coil embolization. Post-embolization angiography confirmed complete occlusion of the pseudoaneurysm with preserved hepatic arterial flow. Early recognition and timely endovascular intervention are essential to prevent life-threatening complications, including rupture and massive hemorrhage.