Giant hepatic artery aneurysm with pylorus fistula

Abstract

Introduction: For hepatic artery aneurysms (HAA) is recommended as first line approach an endovascular treatment. Giant pseudoaneurysms with gastrointestinal fistula are rare and their treatment is tricky. Risks of infection and conversion in case of an endovascular approach should be considered. We describe a giant pseudoaneurysm of the Common Hepatic Artery (CHA) with a fistula on the pylorus, not suitable for endovascular procedure, treated successfully by aneurysm ligation. Case Report: A 73 year-old man presented to our Emergency Department with a symptomatic 9-cm aneurysm of the CHA with a fistula on pylorus, not suitable for endovascular procedure. By open surgery, the CHA was tied, after collaterals patency for a liver perfusion have been assessed. In the immediate post-operative days and in the 2-months follow-up transaminases didn't exceed the normal range. The 2-months ultrasound confirmed the liver good perfusion with normal intra-hepatic signal on color-doppler. Conclusion: In case of CHA aneurysm with fistula in the gastrointestinal tract open surgery may be an option, reducing risks of infection of coils or stent-graft and allowing a definitive treatment, closing the fistula. Preserving the liver flow is always the best solution, but ligation of CHA may be supported by the presence of patent collaterals.

Keywords

• Hepatic artery
• Aneurysm