Spontaneous Rupture of a Saccular Intrahepatic Artery Aneurysm

Abstract

Hepatic artery aneurysms are the second most common visceral aneurysm but are still relatively uncommon. Over the last century, methods for treating these lesions have evolved substantially. The presented case covers the presentation, diagnosis, and treatment of a 65-year-old woman with an aneurysm of the intrahepatic portion of the hepatic artery. This case demonstrates the variety of techniques available for managing these lesions and the importance of both a thorough knowledge of the available treatments and the flexibility to switch among them when necessary.

Coil embolization of ruptured intrahepatic pseudoaneurysm through percutaneous transhepatic biliary drainage

“…Approximately 60% of HAA patients are symptomatic, with the most common symptoms being epigastric and RUQ pain, while Quincke’s triad (abdominal pain, jaundice, and hemobilia) appear in only about 33% of patients [2,8]. In the present case, hemobilia was present in the fluid drained via PTGBD performed on the day after admission; thus, Quincke’s triad was fulfilled.…”

“…In the present case, hemobilia was present in the fluid drained via PTGBD performed on the day after admission; thus, Quincke’s triad was fulfilled. HAA may rupture in the hepatic vein, portal vein, bile duct, or directly into the abdominal cavity, and is diagnosed for the first time in 20-80% of patients when rupture occurs [2,6,9]. Mortality associated with HAA rupture is reportedly 21-43%, while the risk of rupture is high when the aneurysm is ≥2 cm[2,9].…”

“…Abdominal sonography is used for diagnostic screening of HAA, but in most cases, abdominal CT is performed to confirm the relationship between the size of the HAA and surrounding structures [1,6]. Selective angiography is the most sensitive and specific method for diagnosing HAA, and provides important pre- and intra-operative information, such as the location of the aneurysm, anatomical anomalies, and collateral circulation [2,3,6].…”

“…Moreover, re-embolization may also be required since recurrence is found in approximately 37-42% of patients [6-8,10]. If embolization cannot be performed through the hepatic artery or rupture of the intrahepatic artery aneurysm continues despite hepatic artery embolization, ultrasound-guided percutaneous embolization may be performed by directly puncturing the aneurysm sac [2,3]. Surgery involves removal of the aneurysm and suturing the arterial wall or applying a patch suture, with the advantages of reducing the incidence of rebleeding, as well as reducing embolization-related complications, such as vascular occlusion and liver failure [11].…”