Ruptured hepatic artery aneurysm – Case report

Abstract text (incl. references and figure legends)

We present a case of a forty-nine year-old man with a past history of hypertension, nephrolithiasis and diverticulosis. The patient goes to the emergency department complaining of a sudden onset of intense epigastric pain and vomiting.He was apyretic, blood pressure 199/122 mmHg, heart rate 90 bpm, O2 saturation 98% with tenderness of the epigastric region. After being given analgesia, the patient becomes diaphoretic, pale and hypotensive.Blood analysis reveals high lactate levels (3.7 mmol/L) and low hemoglobin (6.0 g/dL). Volume resuscitation yields a good response. Abdominal ultrasound shows intrabdominal fluid and contrast enhanced CT (fig 1) reveals perihepatic fluid and in the parietocolic gutters and a left hepatic artery aneurism (HAA).The patient is taken to the operating room and a massive hemoperitoneum was found (about 2 liters) with a hematoma in the lesser sac. An aneurism in a left hepatic artery branch going to the 4b segment was found and ligated. The patient was then transferred to the ICU and had no complications in the post-operative period, being discharged a week after the surgery. In the follow-up appointments the patient remained asymptomatic and with normal hemoglobin levels.

HAA is quite infrequent with a reported incidence of 0.002-0.4%. Atherosclerosis, mediointimal degeneration, trauma and infection are known risk factors. HAA are difficult to diagnose since most are asymptomatic or are found incidentally. They can also present with rupture with life threatening hemoperitoneum, requiring a rapid response, since this condition can be rapidly fatal. In the acute setting, surgery is the preferred option. In our case simple ligation was feasible since it was a branch aneurism and the patient had no history of liver dysfunction. Otherwise, arterial reconstruction could be needed to prevent liver ischemia and failure

Ref: Man CB et al, Ruptured hepatic artery aneurysm presenting as abdominal pain: a case report. Cases J. 2009 Sep 8;2:8529

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