Skip to content
2000
Volume 20, Issue 1
  • ISSN: 1573-4056
  • E-ISSN: 1875-6603
file format pdf download PDF
side by side viewer icon HTML

Abstract

Background:

Hepatic artery aneurysms (HAAs) exhibit a notable risk of rupture, with both true aneurysms and pseudoaneurysms being exceptionally uncommon (incidence rate approximately 2 per 100,000). Symptoms include epigastric and right upper quadrant pain, jaundice, and potentially life-threatening bleeding upon rupture. This bleeding can extend into the portal vein, hepatic vein, biliary system, or abdominal cavity. While existing literature lacks reports of delayed post-therapeutic complications, this case report discusses a 27-year-old female who developed a pseudoaneurysm six months after bilateral biliary drain insertion, underscoring the potential for delayed complications.

Case Presentation:

The patient underwent gastric endoscopy revealing an extensive lower esophageal varix protruding into the proximal stomach, subsequently treated with banding. The stomach and duodenum were found to contain fresh blood and blood clots indicating acute bleeding.

An urgent CT scan identified active bleeding (extravasation) at segment V and blood accumulation at the confluence of the right and left biliary drains. This was followed by celiac and selective hepatic digital subtraction angiography (DSA).

Conclusion:

This case study outlines the occurrence of a hepatic artery pseudoaneurysm six months after percutaneous insertion of bilateral biliary drains. The pseudoaneurysm manifested precisely at the confluence of the right and left drains. The reported delayed complication may have resulted from friction between the drains at the confluence or erosion of the adjacent artery by the drains. The insights gained from this case shed light on the causes and preventive measures for potential delayed complications associated with percutaneous biliary drain placement.

© 2024 The Author(s). Published by Bentham Science Publisher.
This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Loading

Article metrics loading...

/content/journals/cmir/10.2174/0115734056252548231016052611
2023-10-19
2025-09-10

  • From This Site

    /content/journals/cmir/10.2174/0115734056252548231016052611
    dcterms_title,dcterms_subject,pub_keyword
    -contentType:Contributor -contentType:Concept -contentType:Institution
    10
    5
Loading full text...

Full text loading...

/deliver/fulltext/cmir/20/1/e15734056252548.html?itemId=/content/journals/cmir/10.2174/0115734056252548231016052611&mimeType=html&fmt=ahah

References

  1. SavianoA. OjettiV. ZanzaC. FranceschiF. LonghitanoY. MartuscelliE. MaieseA. VolonninoG. BertozziG. FerraraM. La RussaR. Liver Trauma: Management in the emergency setting and medico-legal implications.Diagnostics2022126145610.3390/diagnostics1206145635741266
     [Google Scholar]
  2. MatsumotoS. CantrellE. JungK. SmithA. CoimbraR. Influence of postoperative hepatic angiography on mortality after laparotomy in Grade IV/V hepatic injuries.J. Trauma Acute Care Surg.201885229029710.1097/TA.000000000000190629613955
     [Google Scholar]
  3. ImamA. SzydloG. AbukhalafS. MikloshB. KedarA. Abu-GazalaS. ZamirG. BloomA. KhalaylehH. PikarskyA.J. KhalailehA. The role of angioembolization in liver trauma: the 10-year retrospective experience of a level one trauma center.Indian J. Surg.202183S115516010.1007/s12262‑021‑02726‑0
     [Google Scholar]
  4. ShaJ. DongY. NiuH. A prospective study of risk factors for in-hospital mortality in patients with malignant obstructive jaundice undergoing percutaneous biliary drainage.Medicine201998
     [Google Scholar]
  5. NikolićI. RadićJ. PetrešA. DjurićA. ProtićM. LitavskiJ. PopovićM. Kolarov-BjelobrkI. DraginS. PopovićL. The clinical benefit of percutaneous transhepatic biliary drainage for malignant biliary tract obstruction.Cancers20221419467310.3390/cancers1419467336230596
     [Google Scholar]
  6. ÁngelG-T.G. SantiagoH-G.F. Preoperative Biliary Drainage: Methods, advantages, and complications in bile duct cancerIntechOpen2019
     [Google Scholar]
  7. QuencerK. TadrosA. MarashiK. CizmanZ. ReinerE. O’HaraR. OkluR. Bleeding after percutaneous transhepatic biliary drainage: Incidence, causes and treatments.J. Clin. Med.2018759410.3390/jcm705009429723964
     [Google Scholar]
  8. PedersoliF. SchröderA. ZimmermannM. Schulze-HagenM. KeilS. UlmerT.F. NeumannU.P. KuhlC.K. BrunersP. IsfortP. Percutaneous transhepatic biliary drainage (PTBD) in patients with dilated vs. nondilated bile ducts: technical considerations and complications.Eur. Radiol.20213153035304110.1007/s00330‑020‑07368‑633051733
     [Google Scholar]
  9. HosnM. A. XuJ. SharafuddinM. CorsonJ. D. Visceral artery aneurysms: Decision making and treatment options in the new era of minimally invasive and endovascular surgeryInternational Journal of Angiology201928011016
     [Google Scholar]
  10. HaghighatkhahH. TaheriM.S. KharaziS.M. ZaminiM. KhorasganiS.R. ZarkaniZ.J. Hepatic artery aneurysms as a rare but important cause of abdominal pain; a case series.Archives of academic emergency medicine20197
     [Google Scholar]
  11. IhoriyaH. MaedaK. IchibaT. InoueF. NaitouH. Upper airway obstruction and hemorrhagic shock due to ruptured aneurysms in a patient with neurofibromatosis type 1.Am. J. Emerg. Med.202143289.e5289.e710.1016/j.ajem.2020.09.07833082060
     [Google Scholar]
  12. RosenbergA. Trebska-McGowanK. ReichmanT. SharmaA. CotterellA. StrifeB. KhanA.A. KumaranV. BrunoD.A. LevyM.F. BhatiC.S. Management of hepatic artery aneurysm: A case series.Ann. Hepatobiliary Pancreat. Surg.202024333333810.14701/ahbps.2020.24.3.33332843601
     [Google Scholar]
  13. ShamiA. Hepatic Artery Aneurysm: A Rare Cause of Abdominal Pain: 2320201710.14309/00000434‑201710001‑02321
     [Google Scholar]
  14. HayashiT. TobitaK. MiyashitaH. MoriyamaN. MurakamiM. SaitoS. Rare complications of pseudoaneurysms of the superior vena cava after transvenous lead extraction.JACC. Case Rep.20224744344810.1016/j.jaccas.2022.03.00135693895
     [Google Scholar]
  15. NassafiE. AnnetL. CiccarelliO. DahlqvistG. Intrahepatic Portal Vein Aneurysm: A case report of an uncanny late complication of liver transplantation202210.1016/j.transproceed.2022.05.013
     [Google Scholar]
  16. PriadkoK. RomanoM. VitaleL.M. NiosiM. De SioI. Asymptomatic portal vein aneurysm: Three case reports.World J. Hepatol.202113451552110.4254/wjh.v13.i4.51533959231
     [Google Scholar]
  17. PatelB. KrishnaswamiM. RamachandranM. GnanaprakasamF. Posttraumatic pseudoaneurysms in hepatic artery branches with endovascular N-butyl cyanoacrylate embolization: case series.Indian Journal of Vascular and Endovascular Surgery2016326210.4103/0972‑0820.183639
     [Google Scholar]
  18. KawsaraA. Núñez GilI.J. AlqahtaniF. MorelandJ. RihalC.S. AlkhouliM. Management of coronary artery aneurysms.JACC Cardiovasc. Interv.201811131211122310.1016/j.jcin.2018.02.04129976357
     [Google Scholar]
  19. IbrahimF. DunnJ. RundbackJ. PelleritoJ. GalmerA. Visceral artery aneurysms: Diagnosis, surveillance, and treatment.Curr. Treat. Options Cardiovasc. Med.201820129710.1007/s11936‑018‑0696‑x30367314
     [Google Scholar]
  20. SellierJ. KaramC. BeauchetA. DallongevilleA. BinsseS. BlivetS. Bourgault-VilladaI. CharronP. ChinetT. EyriesM. FagnouC. LesniakJ. LesurG. LucasJ. Nicod-TranA. OzanneA. PalmyreA. SoubrierF. El HajjamM. LacombeP. Higher prevalence of splenic artery aneurysms in hereditary hemorrhagic telangiectasia: Vascular implications and risk factors.PLoS One2020151e022668110.1371/journal.pone.022668131971937
     [Google Scholar]
  21. MirajkarA. WalkerA. GrayS. WebbA.L. GantiL. Ruptured hepatic artery aneurysm.Cureus202012
     [Google Scholar]
  22. AnJ.Y. LeeJ.S. KimD.R. JangJ.Y. JungH.Y. ParkJ.H. JinS.S. Coil embolization of ruptured intrahepatic pseudoaneurysm through percutaneous transhepatic biliary drainage.Yeungnam Univ. J. Med.201835110911310.12701/yujm.2018.35.1.10931620580
     [Google Scholar]
  23. YangG. HarrisL.M. DosluogluH.H. DryjskiM.L. CherrG.S. Rupture of a previously thrombosed hepatic artery aneurysm.J. Vasc. Surg.20197062033203510.1016/j.jvs.2018.09.06730922753
     [Google Scholar]
  24. RamírezM. Restrepo-CastrillónJ. Hemobilia, a rare cause of upper gastrointestinal bleeding.Rev. Colomb. Gastroenterol.202136263266
     [Google Scholar]
  25. PriyadarshiR.N. KumarR. AnandU. Case report: spontaneous resolution of intracavitary hepatic artery pseudoaneurysm caused by amebic liver abscess following percutaneous drainage.Am. J. Trop. Med. Hyg.2019101115715910.4269/ajtmh.19‑010331162010
     [Google Scholar]
  26. PathakN. PoddarE. ShresthaS. KumariK. RanjanR. SharmaD. DahalR. LakheyP.J. Splenic artery aneurysm with extrahepatic portal venous obstruction: A case report.Int. J. Surg. Case Rep.20229810756810.1016/j.ijscr.2022.10756836380538
     [Google Scholar]
  27. ObaraH. KentaroM. InoueM. KitagawaY. Current management strategies for visceral artery aneurysms: an overview.Surg. Today2020501384910.1007/s00595‑019‑01898‑331620866
     [Google Scholar]
  28. BerryR. HanJ. GirotraM. TabibianJ.H. Hemobilia: Perspective and role of the advanced endoscopist.Gastroenterology research and practice20182018
     [Google Scholar]
  29. BerryR. HanJ. KardashianA.A. LaRussoN.F. TabibianJ.H. Hemobilia: Etiology, diagnosis, and treatment.Liver Res.20182420020810.1016/j.livres.2018.09.00731308984
     [Google Scholar]
  30. ZhornitskiyA. BerryR. HanJ.Y. TabibianJ.H. Hemobilia: Historical overview, clinical update, and current practices.Liver Int.20193981378138810.1111/liv.1411130932305
     [Google Scholar]
  31. KozaY. KayaU. Retrospective analysis of 120 cases of iatrogenic and traumatic peripheral arterial pseudoaneurysms.Eurasian J. Med.202052218018410.5152/eurasianjmed.2019.1842232612428
     [Google Scholar]
  32. GopalP. SubbarayanS. MohanK. AnbalaganA. SK. ShanmugasundaramR. MoorthyN.B.O.L. Post traumatic hepatic artery pseudoaneurysm: A tertiary care centre experience.International Surgery Journal2019693438344210.18203/2349‑2902.isj20194097
     [Google Scholar]
  33. FacundoH.G. MontoliuR.R. LlanosD.R.C. NavalG.S. MillánE.L. GordoS.L. BoschJ.H. RodríguezS.L. BaraneraM.M. MartínezS.G. Cholecystectomy 7 days vs 4 weeks after mild biliary pancreatitis; looking a decrease the incidence of persistent choledocholithiasis and ERCP: A multicentric randomized clinical trial.Int. J. Surg.20229810620710.1016/j.ijsu.2021.10620734995805
     [Google Scholar]
  34. TuranA.S. JenniskensS. MartensJ.M. RuttenM.J.C.M. YoL.S.F. van StrijenM.J.L. DrenthJ.P.H. SiersemaP.D. van GeenenE.J.M. Complications of percutaneous transhepatic cholangiography and biliary drainage, a multicenter observational study.Abdom. Radiol.20214793338334410.1007/s00261‑021‑03207‑434357434
     [Google Scholar]
  35. ShresthaA.K. SahJ.K. GhimireB. BhandariA. ShresthaA. Biliary cripple and the spectrum of complications following cholecystectomy: A case report.Case Reports in Surgery20222022
     [Google Scholar]
  36. PulappadiV.P. SrivastavaD.N. MadhusudhanK.S. Diagnosis and management of hemorrhagic complications of percutaneous transhepatic biliary drainage: a primer for residents.Br. J. Radiol.20219411202020087910.1259/bjr.2020087933529044
     [Google Scholar]
  37. Varga-SzemesA. PenmetsaM. EmrichT. TodoranT.M. SuranyiP. FullerS.R. EdelmanR.R. KoktzoglouI. SchoepfU.J. Diagnostic accuracy of non-contrast quiescent-interval slice-selective (QISS) MRA combined with MRI-based vascular calcification visualization for the assessment of arterial stenosis in patients with lower extremity peripheral artery disease.Eur. Radiol.20213152778278710.1007/s00330‑020‑07386‑433068186
     [Google Scholar]
  38. YamauchiK. UchidaD. KatoH. OkadaH. Recurrent bleeding from a hepatic artery pseudoaneurysm after biliary stent placement.Intern. Med.2018571495210.2169/internalmedicine.8983‑1729033423
     [Google Scholar]
  39. TrojanowskiJ.Q. HarristT.J. AthanasoulisC.A. GreenfieldA.J. Hepatic and splenic infarctions: Complications of therapeutic transcatheter embolization.Am. J. Surg.1980139227227710.1016/0002‑9610(80)90272‑X6965571
     [Google Scholar]
  40. SiablisD. PapathanassiouZ.G. KarnabatidisD. ChristeasN. VagianosC. Hemobilia secondary to hepatic artery pseudoaneurysm: An unusual complication of bile leakage in a patient with a history of a resected IIIb Klatskin tumor.World J. Gastroenterol.200511335229523116127759
     [Google Scholar]
  41. RibeiroA. WilliamsH. MayG. FulmerJ.T. SpiveyJ.R. Hemobilia due to hepatic artery pseudoaneurysm thirteen months after laparoscopic cholecystectomy.J. Clin. Gastroenterol.1998261505310.1097/00004836‑199801000‑000139492864
     [Google Scholar]
/content/journals/cmir/10.2174/0115734056252548231016052611
Loading
Intrahepatic Pseudoaneurysm Developing at the Confluence of Bilateral Biliary Drains Six Months Following a Procedure- A Case Report
Curr. Med. Imaging 20, e15734056252548 (2024); https://doi.org/10.2174/0115734056252548231016052611
/content/journals/cmir/10.2174/0115734056252548231016052611
/content/journals/cmir/10.2174/0115734056252548231016052611
Loading

Data & Media loading...


  • Article Type:     Research Article
Keyword(s): Epigastric pain; Gastric endoscopy; Hepatic artery aneurysm; liver injury; Percutaneous biliary drainage; Pseudoaneurysm

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test