Mycotic Aneurysm of the Hepatic Artery: A Case Report and its Management

Abstract

Cholecystectomies are one of the most common surgical procedures performed in the United States, with complications being relatively common. We submit a case of a ruptured mycotic aneurysm of the hepatic artery, a complication of a recent cholecystectomy which was successfully treated with the use of transarterial thrombin.

Keywords: Angiography; Cholecystectomy; Hepatic artery; Mycotic aneurysm; Thrombin.

Figure 1:

71-year-old male with a recent cholecystectomy who presents with abdominal pain (a) axial contrast-enhanced CT of the abdomen and pelvis demonstrates a large abscess in the right hepatic lobe (arrow). (b) Coronal contrast-enhanced CT of the abdomen and pelvis (right image) demonstrates another large abscess at the base of the right hepatic lobe (arrow) with a medial smaller abscess (arrowhead).

Figure 2:

71-year-old male with a recent cholecystectomy complicated by multiple abdominal abscesses who presents with abdominal pain. (a) Axial contrast-enhanced CT of the abdomen and pelvis (left image) demonstrates placement of drainage catheter in the right hepatic lobe abscess (arrow). (b) Coronal contrast- enhanced CT of the abdomen and pelvis (right image) demonstrates a drainage catheter in the inferior hepatic abscess (arrow) with interval growth of the more medial abscess (arrowhead).

Figure 3:

71-year-old male with a recent cholecystectomy complicated by multiple abdominal abscesses who presents with abdominal pain. Coronal contrast-enhanced CT of the Abdomen and pelvis demonstrates a subtle aneurysmal dilatation of the proper hepatic artery (arrow) concerning for a mycotic aneurysm.

Figure 4:

71 year old male with a recent cholecystectomy complicated by multiple abdominal abscesses who presents with worsening abdominal pain. Angiogram of the hepatic artery demonstrating an aneurysm at the distal hepatic artery (arrow) with no evidence of active bleeding.

Figure 5:

71 year old male with a known mycotic pseudoaneurysm of the hepatic artery presents with worsening abdominal pain. Axial contrast-enhanced image of the abdomen demonstrates interval growth of the mycotic aneurysm (arrow).

Figure 6:

71-year-old male with a known mycotic pseudoaneurysm of the hepatic artery who recently coded on multiple vasopressors. (a) Angiogram at the celiac artery demonstrates no distal flow to the hepatic artery with large active hemorrhage (arrow). (b) Microcatheter was advanced to the distal hepatic artery (arrowhead), with angiogram demonstrating massive active hemorrhage (arrow).

Figure 7:

71-year-old male with a known mycotic pseudoaneurysm of the hepatic artery who recently coded on multiple vasopressors. Angiogram demonstrating multiple coils deployed into the gastroduodenal and proximal proper hepatic artery. Despite the placement of the coils, there is still active contrast extravasation from the aneurysm (arrow).

Figure 8:

71-year-old male with a known mycotic pseudoaneurysm of the hepatic artery who recently coded on multiple vasopressors. After the direct administration of thrombin through the catheter, an angiogram of the celiac artery demonstrates successful embolization and no further extravasation (arrow).