Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5798
Peer-review started: November 23, 2021
First decision: February 7, 2022
Revised: February 27, 2022
Accepted: April 15, 2022
Article in press: April 15, 2022
Published online: June 16, 2022
Processing time: 197 Days and 21.8 Hours
Hepatic artery aneurysm (HAA) is the second most common visceral aneurysm. A significant number of hepatic aneurysms are found accidentally on examination. However, their natural history is characterized by their propensity to rupture, which is very serious and requires urgent treatment. An emergent giant hepatic aneurysm with an abdominal aortic dissection is less commonly reported.
We report the complicated case of a giant hepatic aneurysm with an abdominal aortic dissection. A 66-year-old female presented with the complaint of sudden upper abdominal pain accompanied by vomiting. Physical examination showed that her blood pressure was 214/113 mmHg. Her other vital signs were stable. Computed tomography found a giant hepatic proper aneurysm and dissection of the lower segment of the abdominal aorta. Furthermore, angiography showed a HAA with the maximum diameter of approximately 56 mm originating from the proper hepatic artery and located approximately 15 mm from the involved bifurcation of the left and right hepatic arteries with no collateral circulation. Therefore, we decided to use a stent to isolate the abdominal aortic dissection first, and then performed open repair. After the operation, the patient recovered well without complications, and her 3-month follow-up checkup did not reveal any late complications.
Open surgery is a proven method for treating giant hepatic aneurysms. If the patient's condition is complex, staged surgery is an option.
Core Tip: We report a relatively rare case of a giant hepatic aneurysm combined with abdominal aortic coarctation. The patient had an acute onset and was treated for abdominal aortic coarctation after blood pressure control, followed by a second stage open surgery to manage the hepatic aneurysm in a comprehensive manner. The patient's prognosis is good.