Expand+In Vivoiv.iiarjournals.orgIn Vivo September-October 2017 vol. 31 no. 5 983-989 Management of a Fulminant Upper Gastrointestinal Bleeding Exteriorized Through Hemobilia Due to Arteriobiliary Fistula Between the Common Bile Duct and a Right Hepatic Artery Aneurysm – A Case Report

Abstract

Abstract. Right Hepatic artery aneurysms represent uncommon lesions, accounting for up to 20% of all splanchnic artery aneurysms and are usually asymptomatic lesions, being discovered during various investigations for other pathologies (1). When it comes to the apparition of hepatic artery aneurysms, the main incriminated mechanism is the atherosclerotic one, followed by endocarditis, necrotizing vasculitis, Ehlers Danlos syndrome, Takayasu's arteritis and post-traumatic procedures such as liver transplantation, percutaneous transhepatic cholangiography (2-4). In the study conducted by Stanley et al. on 162 patients diagnosed with various splanchnic aneurysms, the authors demonstrated that 63% of cases reported common and proper hepatic artery aneurysms, 28% of cases were diagnosed with right hepatic artery aneurysms, 5% of cases presented left hepatic artery aneurysms while 4% of cases presented left and right hepatic artery aneurysms (5). Increasing incidence of reported hepatic artery aneurysms which has been reported in the last decade is mainly explained through the improvement of the imagistic techniques, offering a higher rate of aneurysms' detection especially among asymptomatic patients (6). Once hepatic aneurysms are diagnosed, performing an arteriography is 983

Unsuccessful Stent Graft Repair of a Hepatic Artery Aneurysm Presenting with Haemobilia: Case Report and Comprehensive Literature Review

“… Calculus of aneurysm blocking gallbladder “few” days Laparoscopic cholecystectomy None 2012 Yu 19 61 F Pancreatitis Unknown Yes Left HA None Removal of blood clots through ERCP, stable thrombus in pseudoaneurysm None 3 months 2014 Komatsu 20 53 M Marfan syndrome 6.8 Yes Unkown (adjacent to PV) Endovascular Embolisation: coils haemobilia 9 and 11 days 2nd and 3rd embolisation left HA and laparotomy with open resection and left hemihepatectomy 3 years 2016 Vultaggio 21 89 F Atherosclerosis 1.0 No Right HA Endovascular Embolisation: microcoils Cholangitis 2 months Antibiotics None 2017 Bacalbasa 22 68 n.a. Unknown, degenerative Unknown No Common HA, proper HA and GDA (Left HA originated from the left GA) Surgical Right PV embolisation for left liver hypertrophy followed by resection of the aneurysm without initially planned right hepatectomy None None 2017 Bacalbasa 23 66 M Unknown, degenerative Unknown Yes Right HA Endovascular Embolisation: polyvinyl alcohol particles, gelaspone and detachable spirals Pancreatitis and retrograde filling of HAA and PV rupture 3 weeks Open resection HAA and segment of PV with roux and Y, complicated by abscess subhepatic which was drained 3 months 2018 Delgado 24 65 M Endocarditis ...…”

“…In the third case, a choledochal–aneurysmal fistula and portal vein (PV) rupture were found during laparotomy. 23 The HAA was resected en bloc with segmental resection and reconstruction of the PV and CBD. The other 3 complications consisted of cholangitis and an ischaemic gallbladder for which antibiotics were given combined with a cholecystectomy in 2 patients.…”

Major Hepatectomy En Bloc with Cava Vein Resection for Locally Invasive Caudate Lobe Hepatocarcinoma

“…This fact, in association with the global paucity of the liver graft, led to the exclusion of these cases from the waiting lists for liver transplantation [6]. However, the improvement of vascular surgical techniques of resection and reconstruction, the introduction of novel procedures such as ex vivo liver resection or total vascular exclusion, as well as the improvement of perioperative management led to the opportunity of performing extended hepatectomies in association with major vascular resections [6][7][8][9][10][11][12][13].…”

Distal Pancreatectomy En Bloc With Splenectomy, Celiac Axis and Portal Vein Resection Followed by Arterial Reconstruction Using a Cadaveric Graft – A Case Report and Literature Review

“…Due to the fact that pancreatic body tumors remain asymptomatic for a long period of time a significant number of cases will be diagnosed in advanced stages of the disease; therefore, these patients will be diagnosed after a long period of local evolution of the tumoral process that will lead to the apparition of vascular invasion of the surrounding structures (7,8). Although initially it has been considered that the presence of vascular invasion should be considered as a criterion of unresectable lesion, improvement of the surgical techniques led to a higher rate of association of vascular resections; in the meantime the benefit of survival also became evident (9)(10)(11)(12)(13)(14)(15). Therefore, patients submitted to standard pancreatic resections reported similar long-term outcomes when compared to cases submitted to pancreatic resections en bloc with portal vein resection.…”