Atypical presentation of a hepatic artery pseudoaneurysm: A case report and review of the literature

Atypical Presentation of Left Hepatic Artery Pseudoaneurysm

Hepatic artery pseudoaneurysm (HAP) commonly occurs after trauma and is rarely seen as a complication of pyogenic liver abscess. Patients with HAP can present with hemobilia secondary to arterobiliary fistula. We report a case of a 29-year-old woman who presented with abdominal pain, fever, and jaundice, who was diagnosed to have a pyogenic liver abscess that had led to the development of left HAP, presenting with hemobilia. The patient was successfully managed with endovascular coil embolization.

Interdisciplinary Management of Visceral Artery Aneurysms and Visceral Artery Pseudoaneurysms

The paper presents the results of treating 14 patients, namely eight patients with visceral artery aneurysms and six patients with visceral artery pseudoaneurysms. In 64.3% of the patients, the initial diagnosis was made based on the ultrasound examination. All the patients (100%) underwent CT angiography, while angiography was performed in 71.4% of the cases. Five (35.7%) patients with visceral artery pseudoaneurysms were emergently hospitalized; among them, the signs of bleeding were observed in 2 patients. In 9 patients, pathology was detected during tests for other conditions. Five (35.7%) patients underwent endovascular treatment, while 9 (64.3%) patients received surgical treatment. Endovascular interventions and open surgery demonstrated a nil mortality rate. After endovascular treatment, stent thrombosis was found in 1 patient. In the case of surgical treatment, visceral artery aneurysm was observed in 1 patient who underwent the resection of superior mesenteric artery pseudoaneurysm. Conclusions. The choice of the method of treating visceral artery aneurysms and visceral artery pseudoaneurysms depends on the location, size, anatomic features of the visceral arteries and the clinical course of the disease. Both endovascular and surgical treatment demonstrate good postoperative outcomes. Visceral ischemia is one of the most serious complications in the postoperative period, which can complicate both the diagnosis and the choice of treatment tactics.

Massive Gastrointestinal Hemorrhage Due to an Arterioenteric Fistula From a Hepatic Artery Pseudoaneurysm

Hepatic artery pseudoaneurysms are a rare cause of upper gastrointestinal bleeding with a high mortality rate. We report a case of a 37-year-old woman who presented with massive gastrointestinal hemorrhage and was found to have an arterioenteric fistula from a hepatic artery pseudoaneurysm. Esophagogastroduodenoscopy revealed a 1.5-cm ulcer overlying a large mucosal bulge that compressed the lumen of the duodenal bulb. A vascular stent graft was placed successfully over the pseudoaneurysm neck. We report the first case of the unique intraluminal appearance of an enteric fistula related to a hepatic artery pseudoaneurysm.

Aortic and splanchnic artery aneurysms: Unusual causes of biliary obstruction - A retrospective cohort from literature

Mechanical obstruction of the biliary tree and resultant stasis are the cornerstone of a spectrum of diseases ranging from biliary colic to fulminant cholangitis. Infrequently acquired abnormalities of the abdominal vasculature can lead to biliary obstruction. In 2010, we reported a case of acute cholangitis resulting from compression of extra hepatic bile duct by an abdominal aortic aneurysm (AAA). We subsequently conducted a follow up scoping review of literature to identify other cases of acquired abdominal arterial abnormalities resulting in biliary obstruction looking at their management and outcomes. The articles were independently reviewed by two of the authors and pertinent data was extracted. The data was divided on an anatomic basis into two groups: one with primary aortic pathology and one with splanchnic vessel pathology. We identified 39 cases of biliary obstruction secondary to acquired aortic or splanchnic vessel abnormalities; 16 were caused by AAAs and 23 by splanchnic vessels. The cases were managed via conservative, endoscopic, endovascular or open surgical options based on the available technology and expertise. Although uncommon, recognition of aortic and splanchnic arterial abnormalities as a potential cause of biliary obstruction is important as management entails not only cautious decompression of the biliary tree but also addressing the underlying vascular pathology. We recommend that extrinsic biliary compression by an aneurysm or pseudoaneurysm be considered among the differential diagnosis in patients presenting with biliary obstruction and a known lesion of the abdominal vasculature.