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Chirurgia 2020 August;33(4):235-8

DOI: 10.23736/S0394-9508.19.05026-5


lingua: Inglese

Surgical treatment without revascularization of a massive hepatic artery aneurysm with obstructive jaundice

Chang-Bing WU 1, 2, Hong CAO 1, He YU 1, 2, Ping WAN 1

1 Department of Hepatobiliary, Jiangxi Provincial People’s Hospital, Nanchang, China; 2 Medical College of Nanchang University, Nanchang, China

Hepatic artery aneurysms are extremely rare and may be life-threatening. Timely diagnosis and treatment can reduce mortality. We present a case of a 63-year-old man in whom surgical treatment without revascularization of a large hepatic artery aneurysm with obstructive jaundice. A 63-year-old man had upper-abdominal pain and moderate jaundice for >5 months. Enhanced magnetic resonance imaging (MRI) findings indicated a giant hepatic total aneurysm (59×34 mm), which was confirmed with laparotomy. Concurrently, a small, irregular mass in the pancreatic head with an unclear boundary had been touched, and the tumor had invaded the portal vein. It was not known whether the mass was an aneurysm or a lump in the pancreatic head. Intraoperative observations revealed that the left gastric artery supplied the accessory left hepatic artery and a color Doppler ultrasound showed left hepatic arterial blood inflow, despite no obvious arterial blood flow signal in the right hemiliver. Surgical intervention included total hepatic aneurysm resection, pancreaticoduodenectomy, and partial portal vein resection and reconstruction without hepatic artery revascularization. Postoperative recovery was uneventful. He was discharged on postoperative day 25. Liver function improved during the four-month follow-up. A safe and effective treatment for hepatic artery aneurysms is open surgery or endovascular repair. Patient condition, local factors of the aneurysm, and presence of collateral circulation are comprehensive considerations for treatment selection.

KEY WORDS: Hepatic artery; Aneurysms; Reconstructive surgical procedures; Obstructive jaundice; Pancreaticoduodenectomy

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