Abstract
Background. Although rare, visceral artery pseudoaneurysms often present as surgical emergencies with a specific mortality rate as high as 35% related to aneurysmal rupture. Risk factors for the development of iatrogenic pseudoaneurysms include anticoagulation, female gender, obesity, and vessel calcification. Case Report. We present a case of an elderly female who developed a dissecting pseudoaneurysm of the proper hepatic artery after undergoing routine surgery to resect a large duodenal adenoma. Surgical repair comprised of resection and primary anastomosis was employed resulting in a favourable outcome. Discussion/Conclusion. Surgical management reduces the risk of hepatic ischemia, biliary complications, and abscess formation. Although stenting, coil embolization, and thrombin injection are all plausible options for management, we propose that surgical reconstruction be considered seriously as a treatment for such spontaneous pseudoaneurysms.
Highlights
The occurrence of pseudoaneurysms in the splanchnic vasculature is very rare with only a few cases being reported in the literature [1, 2]
We report the first case of a pseudoaneurysm of the proper hepatic artery occurring in a postoperative patient and discuss how to choose the appropriate course of management
Figure 2: ((a), (b)) Coronal computed tomography (CT) scan depicting proper hepatic artery (PHA) aneurysm extending from the origin of the GDA to the bifurcation of the RHA and LHA. (c) Three dimensional CT reconstruction showing anastomosis between remaining PHA and RHA. (d) Enlarged view of coronal CT scan after anastomosis was completed
Summary
Visceral artery pseudoaneurysms often present as surgical emergencies with a specific mortality rate as high as 35% related to aneurysmal rupture. Risk factors for the development of iatrogenic pseudoaneurysms include anticoagulation, female gender, obesity, and vessel calcification. We present a case of an elderly female who developed a dissecting pseudoaneurysm of the proper hepatic artery after undergoing routine surgery to resect a large duodenal adenoma. Surgical repair comprised of resection and primary anastomosis was employed resulting in a favourable outcome. Surgical management reduces the risk of hepatic ischemia, biliary complications, and abscess formation. Coil embolization, and thrombin injection are all plausible options for management, we propose that surgical reconstruction be considered seriously as a treatment for such spontaneous pseudoaneurysms
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