Ruptured hepatic artery aneurysm precipitated by gangrenous perforated appendicitis: a case report

Abstract

Hepatic artery aneurysms are among the most common visceral artery aneurysms although still relatively rare. Repair of aneurysms >2 cm in diameter is important due to the high rate of rupture and associated mortality. Here, we present a case of a sudden rupture of a hepatic artery aneurysm after presentation with a perforated gangrenous appendicitis. There is increasing evidence that expansion and rupture of abdominal aortic aneurysm is related to degradation of elastin and collagen by matrix metalloproteinases (MMPs). Elastin degradation leads to expansion, while collagen degradation leads to rupture. The activity of MMPs has been shown to be upregulated by both sepsis and peritonitis. Here, we suggest that the inflammation from sepsis and peritonitis led to the activation and/or upregulation of MMPs, which precipitated aneurysm rupture via collagenase activity.

The Aftermath of a Hepatic Artery Aneurysm—A Rare Etiology of Biliary Obstruction!

“…Pathologic differences exist between early-stage aneurysms, which exhibit decreased (though abundant) amounts of collagen as compared with normal vascular tissues, and late-stage or ruptured aneurysms, which are composed of mostly fibrin and inflammatory infiltrate on close inspection. These findings have been directly correlated with rupture of abdominal aortic aneurysms (AAAs), and research has only recently begun to extrapolate these findings to include aneurysms of other vessels 5,6…”

Visceralinės Aneurizmos: Literatūros Apžvalga

“…Elastino degradacija sukelia kraujagyslės skersmens didėjimą (aneurizmos atsiradimą), o kolageno degradacija -kraujagyslės vientisumo pažeidimą (aneurizmos plyšimą) [16].…”