Title : Rupture of hepatic artery aneurysm presenting into duodenum: A case report
Abstract:
Hepatic artery aneurysms account for one fifth of splanchnic artery aneurysms and are usually asymptomatic until rupture, at which point, mortality reaches 40% . Appropriate identification can crucially inform intervention options such as endovascular repair or surgical resection.
We report a 56-year-old male who presented with melaena and syncope. CT angiography revealed a common hepatic artery aneurysm bleeding into the duodenum, which was initially treated with endovascular hepatic artery embolisation. The patient returned a month later with fever, tachycardia and abdominal pain. Repeat CT angiography showed recurrence of arterio-enteric fistulation and aneurysmal rupture.
Due to this, surgical resection of the aneurysm was performed. The presence of a dominant left hepatic accessory artery averted the need for vascular repair with grafts. Post-operatively, the patient recovered well and currently remains free from complications 11 months on.
We highlight duodenal fistulation as a rare presentation of hepatic artery aneurysm. We further demonstrate that surgical resection of an infected and enterically-fistulating true aneurysm of the common hepatic artery is a viable option for where endovascular intervention is insufficient. This report adds to limited literature on the surgical management options for hepatic artery aneurysms.
