Pseudoaneurysm of transplant hepatic artery: a late presentation

Abstract

Vascular problems of the hepatic artery account for about 10% of graft loss after liver transplantation (Todo et al, 1987). Of these the majority are secondary to hepatic artery thrombosis (Tobben et al, 1988). In a large survey of transplants, only a small percentage were found to fail as a result of pseudoaneurysm, often at the anastomotic site, and 25% of these were related to infection (Tobben et al, 1988). The potential for early rupture and fatal haemorrhage makes early diagnosis important. In a review of the literature pseudoaneurysms are seen as an early complication and have not been described later than six months (Wozney et al, 1986; Houssin et al, 1988; Tobben et al, 1988; Zayko et al, 1988). We report a late presenting pseudoaneurysm in which no evidence of infection was demonstrated. The importance of early diagnosis and the value of ultrasound are stressed. A 36-year-old female who had required an orthotopic liver transplantation for primary biliary cirrhosis 24 months previously presented with deteriorating liver function and an epigastric mass on routine follow-up. She was otherwise asymptomatic. She had required a laparotomy for a small bowel obstruction due to adhesions seven months after transplantation. She had otherwise been well and had had no major rejection episodes. On examination she was noted to be slightly jaundiced. There was a non-tender palpable liver 4 cm below the costal margin.