Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 28, 2016; 8(18): 779-784
Published online Jun 28, 2016. doi: 10.4254/wjh.v8.i18.779
Atypical presentation of a hepatic artery pseudoaneurysm: A case report and review of the literature
Casey M Luckhurst, Chelsey Perez, Amy L Collinsworth, Jose G Trevino
Casey M Luckhurst, Chelsey Perez, Jose G Trevino, Department of Surgery, Colleges of Medicine, University of Florida Health Science Center, Gainesville, FL 32610, United States
Amy L Collinsworth, Department of Pathology, Colleges of Medicine, University of Florida Health Science Center, Gainesville, FL 32610, United States
Author contributions: All authors have read, approved the final manuscript and agree to be accountable for all aspects of the manuscript ensuring the accuracy and integrity of this manuscript; Luckhurst CM and Perez C participated in the acquisition of data, design and drafting of the manuscript; Collinsworth AL participated in the acquisition and interpretation of data; Trevino JG participated in the conception and design of this manuscript and give final approval of this version of the manuscript to be published.
Institutional review board statement: This manuscript was designed and drafted with approval from University of Florida Institutional Review Board (UF IRB).
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.
Conflict-of-interest statement: All the authors declare they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jose G Trevino, MD, Assistant Professor, Department of Surgery, Colleges of Medicine, University of Florida Health Science Center, Room R6116, Shands Hospital, 1600 SW Archer Rd, Gainesville, FL 32610, United States. jose.trevino@surgery.ufl.edu
Telephone: +1-352-2737967 Fax: +1-352-2650889
Received: March 30, 2016
Peer-review started: March 31, 2016
First decision: May 17, 2016
Revised: May 27, 2016
Accepted: June 1, 2016
Article in press: June 3, 2016
Published online: June 28, 2016
Processing time: 85 Days and 20.5 Hours
Abstract

Classically, hepatic artery pseudoaneurysms (HAPs) arise secondary to trauma or iatrogenic causes. With an increasing prevalence of laparoscopic procedures of the hepatobiliary system the risk of inadvertent injury to arterial vessels is increased. Pseudoaneurysm formation post injury can lead to serious consequences of rupture and subsequent hemorrhage, therefore intervention in all identified visceral pseudoaneurysms has been advocated. A variety of interventional methods have been proposed, with surgical management becoming the last step intervention when minimally invasive therapies have failed. The authors present a case of a HAP in a 56-year-old female presenting with jaundice and pruritis suggestive of a Klatskin’s tumor. This presentation of HAP in a patient without any significant past medical or surgical intervention is atypical when considering that the majority of HAP cases present secondary to iatrogenic causes or trauma. Multiple minimally invasive approaches were employed in an attempt to alleviate the symptomology which included jaundice and associated inflammatory changes. Ultimately, a right hepatic trisegmentectomy was required to adequately relieve the mass effect on biliary outflow obstruction and definitively address the HAP. The presentation of a HAP masquerading as a malignancy with jaundice and pruritis, rather than the classic symptoms of abdominal pain, anemia, and melena, is unique. This presentation is only further complicated by the absent history of either trauma or instrumentation. It is important to be aware of HAPs as a potential cause of jaundice in addition to the more commonly thought of etiologies. Furthermore, given the morbidity and mortality associated with pseudoaneurysm rupture, intervention in identifiable cases, either by minimally invasive or surgical interventions, is recommended.

Keywords: Klatskin tumor; Cholangitis; Hepatic artery pseudoaneurysm; Biliary obstruction; Trisegmentectomy

Core tip: Hepatic artery pseudoaneurysms (HAPs) typically arise from secondary trauma or iatrogenic causes. Most of HAPs are asymptomatic but can be complicated with rupture and bleeding. Biliary obstruction due to HAPs is a rare phenomenon and can present clinically as Quinke’s triad (hematobilia, abdominal pain, and jaundice). Most cases can be managed with non-operative vascular and endoscopic interventions. This case report presents an atypical presentation of HAP with a multidisciplinary approach to a complex problem.