Gastrointestinal hemorrhage caused by rupture of a pseudoaneurysm of the hepatic artery

Abstract

Gastrointestinal bleeding secondary to rupture of a hepatic artery pseudoaneurysm is rare. We report the case of a 61-year-old woman, who was admitted to our institution with hematemesis and melena. Upper gastrointestinal endoscopy and flexible sigmoidoscopy failed to reveal any significant abnormality. Computed tomography scan showed an aneurysm arising from the hepatic artery. A selective angiography showed a ruptured pseudoaneurysm originating from the right hepatic artery with extravasation. It was decided to embolize the pseudoaneurysm, and the neck of the pseudoaneurysm was occluded successfully with two microcoils. While these investigations and interventions were being performed, disseminated intravascular coagulation and acute hepatic failure occurred due to the massive blood transfusion and gross intrahepatic hematoma. Consequently, the patient died 10 days after admission. In this case, we observed that delayed diagnosis of hepatic artery aneurysm rupture may lead to a life-threatening situation. Thus, computed tomography and selective angiography should be obtained immediately. The percutaneous super-selective angiographic embolization of intrahepatic aneurysms is a promising form of treatment, with low risk.