Spontaneous Rupture of a Hepatic Artery Aneurysm: A Case Report, Against the Odds

TL;DR

A rare case of a ruptured hepatic artery aneurysm highlights the importance of early diagnosis and endovascular treatment for better patient outcomes.

Contribution

This case report emphasizes the under-recognized risk of hepatic artery aneurysms and advocates for improved early detection and endovascular intervention.

Findings

A 57-year-old woman survived a ruptured hepatic artery aneurysm after successful coil embolization.

Endovascular approaches are preferred over open surgery for ruptured hepatic artery aneurysms.

Early diagnosis and aggressive intervention improve survival chances in such cases.

Abstract

Ruptured aneurysms are associated with significant mortality limiting a patient’s chances of survival, making early and accurate diagnoses crucial. A commonly overlooked cause is the hepatic artery aneurysm, where most patients exhibit no distinct symptoms and detection typically occurs only after the aneurysm has ruptured. Hepatic artery aneurysms are linked with high rupturing rates resulting in substantial mortality when compared to other splanchnic artery aneurysms. Enhancing recognition and consideration of splanchnic artery aneurysms, including hepatic artery aneurysms, will increase a patient’s odds of a successful recovery. The following case report illustrates the critical nature of these cases and highlights how important early diagnosis and aggressive intervention are to prevent death once rupture of the hepatic artery aneurysm has occurred.

A 57-year-old female presented to the emergency department brought in by helicopter for generalized chest and abdominal pain. A computed tomography angiography of the chest, abdomen, and pelvis was performed and revealed a saccular aneurysm exhibiting multiple lobes in the left hepatic artery accompanied by hemoperitoneum confirming a spontaneous rupture. As a result of the ruptured aneurysm, it was decided an immediate coil embolization was necessary. Ultimately the patient underwent a successful coil embolization and was transferred to a facility with hepatobiliary and transplant surgery capabilities. She remained stable, was extubated the following day, and did not require any additional surgeries.

By encompassing hepatic and associated splanchnic artery aneurysms in the diagnosis of patients with abdominal pain and signs of hemodynamic instability, physicians can improve early identification, facilitating early endovascular repair and improved patient outcomes. It is a rare diagnosis that can present with a wide range of symptoms. Currently, endovascular approaches for ruptured hepatic artery aneurysms are preferred over open surgery.

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