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. 2018:51:95-98.
doi: 10.1016/j.ijscr.2018.08.020. Epub 2018 Aug 19.

Surgical treatment of a huge hepatic artery aneurysm without revascularization-Case Report

Tomohiro Imazuru  1 , Masateru Uchiyama  2 , Shigefumi Matsuyama  3 , Mitsuru Iida  4 , Tomoki Shimokawa  5
Affiliations

Surgical treatment of a huge hepatic artery aneurysm without revascularization-Case Report

Tomohiro Imazuru et al. Int J Surg Case Rep. 2018.

Abstract

Introduction: Hepatic artery aneurysms (HAA) are rare and life-threatening.

Presentation of case: We report a case of a 68-year-old man with a huge HAA diagnosed incidentally. Computed tomography showed a huge HAA (67-84 mm diameter). The patient underwent aneurysm resection and ligation of the common and proper hepatic arteries via laparotomy. Revascularization was not performed because intraoperative ultrasound showed pulsatile inflow to the left hepatic lobe. Postoperative cholecystitis and hepatic infarction were temporarily observed. Two months after the previous discharge, cholecystectomy was performed.

Discussion: A diameter ≥5 cm of HAA is thought to be rare in arterial aneurysm diseases. There is no consensus in the treatment policy and treatment is selected according to the patient's condition. In this case, we selected open surgery for this patient instead of endovascular surgery due to rupture risks, irregularity and narrowness of vessel structure, and prolonged irradiation-time. If revascularization is not performed at the time of resection, open surgery with cholecystectomy is capable of preventing postoperative cholangitis after resection of HAA, and should be taken into account even if collateral circulation can be confirmed.

Conclusion: This case highlights the difficulty of managing HAA and provides insight into a successful surgical treatment of HAA without complete revascularization.

Keywords: A huge hepatic artery aneurysm; Case report; Cholecystectomy; Hepatic artery aneurysm; Open surgery; Revascularization.

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Figures

Fig. 1
Fig. 1
Computed tomography (CT) scan before surgical operation. (a) Branch section of celiac artery, (1) common hepatic artery. (b) Maximum of a huge hepatic artery aneurysm (HAA) with 67mm∼84 mm. (c) The origin of a HAA, (2) the entry of common hepatic artery. (d) 3-D reconstruction CT imaging for a HAA.
Fig. 2
Fig. 2
HAA under operation. (a) bilateral proper hepatic arteries shown as (1), and (b) inside of the aneurysm after clump and incision, (2) common hepatic artery and (3) inlet of the aneurysm.
Fig. 3
Fig. 3
CT scan on day 7 after aneurysm resection. Cholecystitis and hepatic infarction of medial segment of left hepatic lobe were confirmed.
See this image and copyright information in PMC

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