Obstructive jaundice by a dissecting aneurysm of celiac axis and hepatic artery

Summary We report a case of dissecting aneurysm of the celiac axis and hepatic artery resulting in obstructive jaundice. The aneurysm was demonstrated both by ultrasound and by angiography, but the associated aortic dissection was apparent only on CT scan. The patient was treated with percutaneous transhepatic biliary drainage, surgical exclusion of the aneurysm by ligation, and progressive dearterialization of the hepatic artery.     

Difficulty in diagnosing hemobilia from a hepatic artery aneurysm: value of endoscopic retrograde cholangiography

A case of hemobilia due to a hepatic artery aneurysm is described. Despite 2 arteriograms and 2 laparotomies, the cause of the bleeding remained undetected until a further selective cannulation of the celiac axis artery was performed. Endoscopic retrograde cholangiography demonstrated that postoperative jaundice was not due to obstruction and outlined the aneurysm within a hepatic duct.     

Jaundice Secondary to Hepatic Artery Aneurysm: Radiological Appearance and Clinical Features

Hepatic artery aneurysm comprises only 20% of all visceral aneurysms. The classical triad of abdominal pain, hemobilia, and jaundice is seen in less than one-third of cases. Up to 60% of patients present with an abdominal catastrophe. In our case of hepatic artery aneurysm, the diagnosis was suggested by CT scan and confirmed by angiography. Its appearance is also demonstrated on sonogram and cholangiogram. To our knowledge, this is the first case to be reported where the aneurysm was demonstrated on multiple radiographic images.     

An unusual cause of obstructive jaundice: giant gastroduodenal artery aneurysm

Visceral artery aneurysms are rare vascular lesions. Hepatic aneurysms are the second most common type of visceral aneurysm after those of the splenic artery. These aneurysms often have a nonspecific clinical presentation and are difficult to diagnose before rupture. Because the natural course of hepatic aneurysms leads to rupture, with a high rate of morbidity and mortality, their early diagnosis is essential for surgical correction. We report a case of obstructive jaundice caused by a 7-cm gastroduodenal artery aneurysm in which the diagnosis was suggested by abdominal computed tomography and magnetic resonance cholangiography and was confirmed by angiography. The patient was surgically treated. In the following 48 h he presented ischemic-based acute hepatic failure and underwent left hepatic lobe resection. The patient finally died from a pulmonary thromboembolism.     

Pseudoaneurysm of the cystic artery associated with upper gastrointestinal bleeding

Pseudoaneurysm of the cystic artery is a cause of hemobilia, and is extremely rare, with only eight cases having been reported in the world literature. We report a case of pseudoaneurysm of the cystic artery in a 72-year-old Japanese man. The patient experienced epigastric pain and melena, and was found to have jaundice and liver dysfunction. Repeated gastroendoscopy did not reveal the cause of the alimentary tract bleeding; however, color-Doppler ultrasonography detected an aneurysm of the cystic artery in the gallbladder. Selective hepatic arteriography demonstrated that the posterior branch of the cystic artery was markedly dilated and that an aneurysm had formed in the midst of the artery. We diagnosed hemobilia due to the pseudoaneurysm of the cystic artery, and associated gastrointestinal bleeding. Cholecystectomy was performed immediately. Pathologically, the gallbladder showed acute calculous cholecystitis. This case emphasizes the importance of including hemobilia in the differential diagnosis whenever gastrointestinal bleeding is associated with signs of biliary disorder; color-Doppler imaging is a favorable modality for the diagnosis of pseudoaneurysm of the cystic artery.     

Hepatic Artery Aneurysms

Four patients with hepatic artery aneurysm are reported. Two patients presented with abdominal pain, initially considered a consequence of pancreatic disease. A third patient had a sudden onset with hemoperitoneum and shock. In the fourth patient the aneurysm burst into the common bile duct causing hemobilia and jaundice. All were successfully treated with hepatic artery ligation, which left the patient free of symptoms during long-term follow-up. Arteriography should facilitate diagnosis and artery ligation appears the best treatment.     

Present management of hepatic artery aneurysms. Symptomatic left hepatic artery aneurysm; right hepatic artery aneurysm with erosion into the gallbladder and simultaneous colocholecystic fistula--a report of two unusual cases and the current state of etiology, diagnosis, histology and treatment.

A left hepatic artery aneurysm has an incidence of 0.8% among the splanchnic artery aneurysms. 20% of splanchnic artery aneurysms are hepatic artery aneurysms. Atherosclerosis (32%) is the most prevalent etiology, followed by trauma (22%) and inflammatory lesions (10%). The average age is 40 (10-83) years, the male to female ratio 2:1. In 64-80% of cases rupture of the aneurysm is the first clinical manifestation. The mortality is then about 35%. The case of a 64 years old female with a symptomatic aneurysm of the left hepatic artery and the case of a 70 years old female, who underwent emergency laparotomy for acute colorectal hemorrhage, with a right hepatic artery aneurysm, which perforated into the gallbladder, with simultaneous colocholecystic fistula is reported and the etiology, histology, and present diagnostic and therapeutic management of hepatic artery aneurysms is discussed.     

Abdominal crisis in a young man with systemic lupus erythematosus

Medium-sized artery aneurysms are rare in patients with systemic lupus erythematosus (SLE). We report on a 21-year-old Chinese man with SLE and secondary antiphospholipid syndrome (APS) who presented with acute abdominal pain due to a ruptured right hepatic artery aneurysm. He was also found to have aneurysms of the left hepatic artery and splenic artery on autopsy. There have been only eight cases of hepatic artery aneurysm and one case of splenic artery aneurysm associated with SLE in the English literature. Abdominal aneurysm must be suspected in SLE patients presenting with acute abdominal pain, haemoperitoneum or occult bleeding.     

Spontaneous rupture of a congenital hepatic artery aneurysm

A 74-year-old woman with new, but vague abdominal pain developed an intra-abdominal hemorrhage. Ultrasound and CT scans before and after this event demonstrated an acute hepatic lesion with hemorrhage into the peritoneal cavity. The patient died, and a ruptured hepatic artery aneurysm was revealed at autopsy. Hepatic artery aneurysm is uncommon, usually extra-hepatic, and, in most cases, is caused by atherosclerosis, medial degeneration, trauma, or infection. In this case, the aneurysm was intrahepatic and no underlying abnormalities of the hepatic vessels were found. We discuss the clinical scenario of patients with hepatic artery aneurysm and stress the importance of considering the diagnosis in the setting of a catastrophic abdominal event. In addition, the various diagnostic and therapeutic options are explored.     

肠系膜上动脉瘤合并梗阻性黄疸1例报道并文献复习

肠系膜上动脉瘤压迫导致梗阻性黄疸的病例非常罕见,治疗方式以手术为主。现报道我院收治的1例患者的治疗经过,供临床参考。     

Recurrent bleeding from a hepatic artery aneurysm feeding a large cavernous hemangioma of the liver

We describe a patient with an aneurysmatic dilatation of the hepatic artery feeding a giant cavernous hemangioma. The 51-years-old man presented with massive gastrointestinal hemorrhage due to chronic rupture of the aneurysm into the pancreatic duct. The patient died 25 days after resection of the aneurysm in liver failure and septic shock. We think that this cavernous hemangioma was responsible for a high blood flow within the hepatic artery for many years. This high blood flow caused the degenerative alterations in the wall of the artery, resulting in aneurysm formation and rupture. This is the first case mentioned in literature with rupture of a hepatic aneurysm generated by high blood flow.     

Congenital hepatic artery aneurysm: a case report in early infancy

Hepatic artery aneurysm in children is a very unusual pathologic entity. As most patients with this anomaly are asymptomatic, the diagnosis is usually made as an incidental finding on imaging studies performed for other reasons. Here, we report a 35-day-old infant with hepatic artery aneurysm, which was diagnosed accidentally as a liver mass during echocardiography. Considering the age of diagnosis, she most likely had a congenital type of hepatic artery aneurysm. To the best of our knowledge, this is the youngest case to be reported in the literature.     

Transcatheter endovascular therapy of a traumatic common hepatic artery aneurysm

Dilemma was encountered regarding diagnosis and treatment when a farmer presented with a progressively increasing pulsatile abdominal mass and signs of obstructive jaundice. A computerized tomographic scan reported it to be a pancreatic pathology, but angiographically it was found to be a large aneurysm arising from the common hepatic artery. Surgery was thought to be highly risky; therefore, a transcatheter technique was successfully applied to tackle this life-threatening situation.     

Hepatic artery aneurysm treatment with heparin-bonded covered stent: a case report

The hepatic artery is the second most common site for aneurysms formation within the splanchnic circulation. Most hepatic artery aneurysms (HAA) are diagnosed incidentally by a computed tomography(CT) scan or a Doppler ultrasonography. We present the case of a HAA diagnosed preoperatively in a 82-year old man, who was treated with an endovascular procedure. An abdominal ultrasonography revealed by chance the presence of a HAA. The abdominal CT scan confirmed an aneurysm of the common hepatic artery, specifically at the origin of the gastroduodenal artery. The gastroduodenal artery was embolized using coils then a heparin-bonded covered stent was deployed into the common hepatic artery to exclude the aneurysm. Final arteriogram documented the regular patency of the stent and the complete exclusion of the aneurysm. No complication occurred and the patient was discharged on the second postoperative day. Six months later, a follow-up with a Duplex scan confirmed the regular patency of the stent, and the patient was in good clinical conditions.     

Pseudoaneurysm of cystic artery after laparoscopic cholecystectomy

Background. The formation of a pseudoaneurysm of the cystic artery is a rare occurrence after laparoscopic cholecystectomy. Case outline. Seven weeks after laparoscopic cholecystectomy, a 31-year-old woman presented with a picture of obstructive jaundice. The diagnosis of cystic artery aneurysm was verified by arteriography, CT and MRCP. At laparotomy the pseudoaneurysm was found to be compressing the common bile duct. It was successfully managed by ligation of the right hepatic artery. Discussion. Although this complication is rare, the surgeon must have a high index of suspicion to make the diagnosis.     

A case of polyarteritis nodosa with intra-abdominal bleeding due to rupture of the hepatic aneurysm]

A 39-year-old woman was admitted to our hospital because of abdominal pain. She was diagnosed as intra-abdominal bleeding and an emergency laparotomy was performed. On laparotomy, massive bleeding in the abdominal cavity due to a ruptured aneurysm of the intrahepatic artery was found. We also verified small aneurysm of the common hepatic artery, tinged with red, and was suspected systemic vasculitis. The post-operative course was uneventful, but the subsequent angiography revealed many other small aneurysm of hepatic, renal and lumbar aytery. Then it was diagnosed as polyarteritis nodosa. A case of polyarteritis nodosa presenting with intra-abdominal homorrhage like this case is rare, so we presented here together with a review of the literature.     

A case of amebic liver abscess complicated by hemobilia due to rupture of hepatic artery aneurysm

We report the case of a 51-year-old man with hepatic amebic abscess complicated by hepatic artery aneurysm. The patient first presented with peritonitis caused by perforating appendicitis. Surgical treatment resolved peritonitis but Entamoeba histolytica was detected in the colonic mucosa. Subsequently, liver abscess developed and the size of the abscess increased gradually after surgery in spite of continued treatment with metronidazole. Brown pus was drained from the abscess but 13 days after the drainage process the patient complained of right upper abdominal pain and the drained fluid became blood-colored and stool became tarry in color. Enhanced computed tomography showed a hepatic artery aneurysm that had ruptured into the liver abscess and duodenoscopy revealed bleeding from the ampulla of Vater. Transcatheter arterial embolization with several steel coils was successfully performed which resulted in cessation of bleeding from the ampulla of Vater. The patient was discharged without any complications five weeks after rupture of the aneurysm. Our case demonstrates rupture of the hepatic artery aneurysm as a rare complication of amebic liver abscess and the effectiveness of interventional embolotherapy in this condition.     

Rupture of hepatic aneurysm complicating hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) for which hepatic arterial coil embolization was effective

A 74-year-old woman was transferred to our hospital for further examinations because of abdominal fullness and abnormal levels of serum liver/biliary enzyme persisting for 3 weeks. She had anemia and dilatation of many capillary vessels in her fingers, palms, and tongue in addition to reporting frequent incidences of nasal bleeding in herself and her family. Abdominal ultrasonography detected a cystic lesion in the right hepatic lobe, connected to a dilated tortuous hepatic artery. A low-echoic hepatic phyma was also detected in the back of the cystic lesion. Abdominal computed tomography and magnetic resonance imaging indicated that the cystic lesion was an aneurysm and the low-echoic phyma was a hematoma. Hepatic arteriography confirmed a hepatic aneurysm, tortuous dilatation of the hepatic artery, and the complication of an arteriovenous shunt in the liver. Taking all of these findings into consideration, this case was diagnosed as hereditary hemorrhagic telangiectasia (HTT) complicated by a hepatic aneurysm causing intrahepatic hematoma. To prevent re-rupture of the aneurysm, we performed a hepatic arterial coil embolization. After therapy, no blood flow to the aneurysm was detected by ultrasonic color Doppler method and the hematoma gradually diminished. There have been no reports of a case in which hepatic arterial embolization was effective for HHT-associated hepatic aneurysm causing intrahepatic hematoma. This very rare case provides important clinical information regarding abdominal vascular complications of HTT and a less invasive treatment for them.     

Gastrointestinal hemorrhage caused by rupture of a pseudoaneurysm of the hepatic artery

Gastrointestinal bleeding secondary to rupture of a hepatic artery pseudoaneurysm is rare. We report the case of a 61-year-old woman, who was admitted to our institution with hematemesis and melena. Upper gastrointestinal endoscopy and flexible sigmoidoscopy failed to reveal any significant abnormality. Computed tomography scan showed an aneurysm arising from the hepatic artery. A selective angiography showed a ruptured pseudoaneurysm originating from the right hepatic artery with extravasation. It was decided to embolize the pseudoaneurysm, and the neck of the pseudoaneurysm was occluded successfully with two microcoils. While these investigations and interventions were being performed, disseminated intravascular coagulation and acute hepatic failure occurred due to the massive blood transfusion and gross intrahepatic hematoma. Consequently, the patient died 10 days after admission. In this case, we observed that delayed diagnosis of hepatic artery aneurysm rupture may lead to a life-threatening situation. Thus, computed tomography and selective angiography should be obtained immediately. The percutaneous super-selective angiographic embolization of intrahepatic aneurysms is a promising form of treatment, with low risk.     

Curable asystole in an adult caused by a diffuse and complete arteriovenous aneurysm of the liver. Cure by ligation of the hepatic artery

A case of cardiac failure in a 54 year old man with a diffuse total arteriovenous aneurysm of the liver is reported. The aneurysm was arteriolarvenous, without a wide bore localised fistula. It occupied the whole hepatic mass, including the territories of the right subphrenic and anterior collateral of the gastroduodenal artery. The cause of cardiac failure was the elevated cardiac output, 15 1/min, which fell to 6 1/min at each peroperative occlusion of the hepatic artery. After ligature of this vessel, the cardiac output stabilised at 9 1/min and remained at this value 4 months after surgical cure. This case is comparable to the neonatal cardiac failure due to multinodular hepatic angioma with respect to the clinical, angiographic and CAT scan characteristics, and the surgical cure of the high cardiac output syndrome. Some of the histological features were suggestive, in places, of the structure of hepatic cavernoma, which makes the exact pathological classification of this diffuse aneurysm difficult; the closest possibility being an involuted from of diffuse capillary hemangioma of childhood allowing such long survival and, occasionally taking on the appearances of a cavernoma. Permanent surgical cure by ligature of the hepatic artery was an additional rare feature of this case.