Gastrointestinal bleeding and obstructive jaundice: Think of hepatic artery aneurysm

Abstract

Hemobilia is an uncommon and potential life-threatening condition mainly due to hepato-biliary tree traumatic or iatrogenic injuries. Spontaneously ruptured aneurysm of the hepatic artery is seldom described. We report the case of an 89-year-old woman presenting with abdominal pain, jaundice and gastrointestinal bleeding, whose ultrasound and computed tomography revealed a non-traumatic, spontaneous aneurysm of the right hepatic artery. The oeso-gastro-duodenoscopy and colonoscopy did not reveal any bleeding at the ampulla of Vater, nor anywhere else. Selective angiography confirmed the diagnosis of hepatic artery aneurysm and revealed a full hepatic artery originating from the superior mesenteric artery. The patient was successfully treated by selective embolization of microcoils. We discuss the etiologies of hemobilia and its treatment with selective embolization, which remains favored over surgical treatment. Although aneurysm of the hepatic artery is rare, especially without trauma, a high index of suspicion is needed in order to ensure appropriate treatment.

Keywords: Hemobilia; Hepatic artery aneurysm; Obstructive jaundice; Supra-selective micro-embolization; Gastrointestinal hemorrhage

Core tip: Non-traumatic aneurysm of the hepatic artery leading to hemobilia as the source of gastrointestinal bleeding may be subtle to recognize, not only because of its low incidence but also because of its inconsistent clinical signs. These aneurysms are more commonly seen after a traumatic event on the biliary tree, however in rare cases, it occurs spontaneously, mainly in the settings of vascular degeneration and chronic gallbladder inflammatory disease. Moreover, the hepatic artery is known for multiple anatomical variants, some of which are rare. Our patient presented with both uncommon conditions and was successfully treated with micro-coils embolization.