Contained rupture of a large right hepatic artery aneurysm: the ticking bomb within!

Byju Kundil, Mano Zac Mathews, Tina Tony, Robin Kurian


Hepatic artery aneurysms (HAAs) are rare and represents one fifth of visceral aneurysms. We report a case of a 75 year old female who presented to the outpatient department with complaints of abdominal pain and anorexia for 2 weeks. On examination the patient was stable, she had mild tenderness in the right hypochondrial region. Ultrasound abdomen showed an intrahepatic cystic area with both arterial and venous flow, suggesting the possibility of an intrahepatic arteriovenous malformation. Contrast-enhanced computed tomography abdomen showed a large right HAA with contained rupture and intra hepatic extension. She was posted for emergency laparotomy and was found to have a contained rupture a contained rupture of the right HAA of size 10×8 cm with intra hepatic extension. Right hepatectomy was done and the resected margin of liver showed a dilated cystic space with blood clot. Histopathological examination showed intrahepatic aneurysm with atherosclerosis and laminated luminal thrombus. Contained rupture of HAAs with intrahepatic extension are rare. Even though the prevalence of HAAs is low, the risk of rupture is reported to be as high as 20-80% and the mortality following spontaneous rupture is 40%. Hence an aggressive approach to the management of HAA is required whenever detected.


Hepatic artery aneurysm, Contained rupture, Right hepatectomy, Atherosclerosis

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Carr SC, Pearce WH, Vogelzang RL, Carthy MWJ, Nemcek AA, Yao JS. Current management of visceral artery aneurysms. Surgery. 1996;120(4):627-34.

Guida PM, Moore SW. Aneurysm of the hepatic artery. Report of five cases with a brief review of previously reported cases. Surgery. 1966;60(2):299-310.

Belli AM, Markose G, Morgan R. The role of interventional radiology in the management of abdominal visceral artery aneurysms. Cardiovasc Intervent Radiol. 2012;35:234-43.

Pulli R, Dorigo W, Troisi N. Surgical treatment of visceral artery aneurysms: a 25 years experience. J Vasc Surg. 2008;48:334-42.

Woj WT. Managing visceral artery aneurysms; Current endovascular techniques and technologies for treating this increasingly encountered presentation. Endovascular Today. 2013:77-81.

Arneson MA, Smith RS. Ruptured hepatic artery aneurysm: case report and review of literature. Ann Vasc Surg. 2005;19:540-5.

Abbas MA, Fowl RJ, Stone WM, Panneton JM, Oldenburg WA, Bower TC, et al. Hepatic artery aneurysm: Factors that predict complications. J Vasc Surg. 2003;38:41-5.

Marone EM, Mascia D, Kahlberg A, Brioschi C, Tshomba Y, Chiesa R. Is open repair still the gold standard in visceral artery aneurysm management. Ann Vasc Surg. 2011;25(7):936-46.

Bakker DMA, Tangkau PL, Steffens TW, Tjiam L, Loo VEM. Rupture of a hepatic artery aneurysm caused by Wegener’s granulomatosis. Pathol Res Prac. 1997;193:61-6.

Khodja HR, Declemy S, Batt M, Castanet J, Perri C, Ortonne JP, et al. Visceral artery aneurysms in von Recklinghausen’s neurofibromatosis. J Vasc Surg. 1997;25:572-5.

Tulsyan N, Kashyap VS, Greenberg RK. The endovascular management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg. 2007;45(2):276-83.

Cooper SG, Richman AH. Spontaneous rupture of a congenital hepatic artery aneurysm. J Clin Gastroenterol. 1988;10:104-7.

Baggio E, Migliara B, Lipari G, Landoni L. Treatment of six hepatic artery aneurysms. Ann Vasc Surg. 2004;18:93-9.

Wagner WH, Allins AD, Treiman RL, Cohen JL, Foran RF, Levin PM, et al. Ruptured visceral artery aneurysms. Ann Vasc Surg. 1997;11:342-7.

Shanley CJ, Shah NL, Messina LM. Common splanchnic artery aneurysms: splenic, hepatic, and celiac. Ann Vasc Surg. 1996;10(3):315-22.

Arneson MA, Smith RS. Ruptured hepatic artery aneurysm: case report and review of literature. Ann Vasc Surg. 2005;19:540-5.

Regus S, Lang W. Rupture Risk and Etiology of Visceral Artery Aneurysms and Pseudo aneurysms: A Single-Center Experience. Vascular Endovascular Surg. 2016;50(1):10-15.

Andrew DR, Vive JU, Macpherson DS. Successful resection of a massive hepatic artery aneurysm. J R Army Med Corps. 1994;140:138-40.

Lumsden AB, Mattar SG, Allen RC, Bacha EA. Hepatic artery aneurysms: the management of 22 patients. J Surg Res. 1996;60:345-50.