Revisiting Quincke’s Triad: A Case of Idiopathic Hepatic Artery Aneurysm Presenting with Obstructive Jaundice

Hepatic artery aneurysm: A rare but significant differential diagnosis

“…1 To be recognised as a HAA, the hepatic artery must increase to at least 50% of its normal diameter. 5 Typically, the mean diameter of the common hepatic artery in male patients is 5.4 mm, ranging from 3 to 9 mm. 6 The patient this case study is referring to had a hepatic artery diameter of 35 mm, making it almost 6.5 times as large as the mean.…”

“…Hepatic artery aneurysms are found most frequently in men, more commonly in the sixth decade with a background of severe atherosclerosis. 2,5,7 Other common causes have been described including hypertension, vascular disease, pancreatitis, diabetes, tobacco use, fibromuscular dysplasia, autoimmune diseases, and infections. 7,8 It should be noted that up to 50% of HAAs should be classified as hepatic artery pseudoaneurysms.…”

“…In recent years, the incidence of hepatic artery pseudoaneurysms has increased due to a rapidly increasing number of upper abdominal and hepatobiliary procedures, including percutaneous procedures and liver transplantation. 5 The aetiology of pseudoaneurysms is largely iatrogenic, as mechanical vascular injury can occur during the surgical procedures. 9 The natural progression of a HAA is gradual enlargement, with increasing risk of rupture and death.…”

“…8 A ruptured intrahepatic aneurysm however is more likely to rupture into the biliary tract, with one third of symptomatic patients presenting with Quincke's triad of haemobilia; obstructive jaundice, abdominal pain, and upper gastro-intestinal bleeding. 3,5,11 Haemobilia is caused when a connection exists between the splanchnic vessels and the intra-or extra-hepatic biliary system. In the case of a HAA, over time, the presence of the aneurysm can cause erosion or potentially rupture into the biliary tree.…”

“…In the case of a HAA, over time, the presence of the aneurysm can cause erosion or potentially rupture into the biliary tree. 5 As HAAs have high rates of rupture and associated mortality rates, various treatment options will be pursued to avoid this. When found, current guidelines recommend that all symptomatic HAAs (due to compression of the biliary tree), or HAAs greater than 2 cm be surgically repaired if patient comorbidities permit.…”