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Case Reports
. 2021 Apr:81:105816.
doi: 10.1016/j.ijscr.2021.105816. Epub 2021 Mar 23.

Common hepatic artery pseudoaneurysm: A rare complication following total gastrectomy: A case report

Sanjeev Kharel  1 , Suraj Shrestha  2 , Nitin Gyawali  3 , Narendra Maharjan  4 , Ajit Thapa  5 , Bishnu Prasad Kandel  6 , Paleswan Joshi Lakhey  7
Affiliations
Case Reports

Common hepatic artery pseudoaneurysm: A rare complication following total gastrectomy: A case report

Sanjeev Kharel et al. Int J Surg Case Rep. 2021 Apr.

Abstract

Introduction and importance: Common Hepatic Artery (CHA) Pseudoaneurysm is a rare entity, attributed to infections, trauma, and upper abdominal surgery. Most cases occur after biliary and pancreatic surgery. CHA pseudoaneurysm after total gastrectomy is uncommon and can be devastating.

Case presentation: A 58-years male who underwent D2 total gastrectomy for gastric carcinoma ten days ago, presented with hematemesis, epigastric pain, and a history of melaena. After admission, upper gastrointestinal endoscopy showed a clot at the jejunojejunostomy site. Computed tomography with angiography was diagnostic of pseudoaneurysm of CHA located inferiorly. Coil embolization of CHA was done and the patient improved.

Clinical discussion: Pseudoaneurysm of the common hepatic artery is a serious complication after abdominal surgery. Only a few cases have been reported with similar symptoms related to gastrointestinal bleeding following various upper abdominal surgeries. Coil embolization is a gold standard technique with a high success rate.

Conclusion: CHA pseudoaneurysm is a dreadful potential complication of abdominal surgery including gastrectomy. Early recognition and emergency management of CHA pseudoaneurysm are crucial for a favorable outcome for patients with bleeding from CHA aneurysm.

Keywords: Common hepatic artery; Embolization; Gastrectomy; Pseudoaneurysm.

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Figures

Fig. 1
Fig. 1
Upper GI endoscopy a) shows clot at jejunojejunostomy site with oozing b) intact jejunal limb and c) intact esophagojejunostomy site.
Fig. 2
Fig. 2
CECT abdomen and pelvis showed patent uncomplicated esophagojejunostomy anastomosis with saccular contrast filled outpouching located inferiorly of CHA (red arrow) with hyperdense contents contiguous with lesion in arterial phase (blue arrow).
Fig. 3
Fig. 3
CT angiography of celiac trunk showing sac or protuberance (pseudoaneurysm) in the inferior section of CHA (arrow).
Fig. 4
Fig. 4
Coil embolization a) before and b) after coil embolization treatment of the common hepatic pseudoaneurysm.
See this image and copyright information in PMC

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