Extended surgery for the hepatic artery aneurysm involving duodenum and pancreas--a case report.
Hepatic artery aneurysms have been the most frequently reported splanchnic artery aneurysms in the past decade. Due to the complex anatomy and sensitivity of the liver to ischemic injury, a number of therapeutic alternatives exist in repairing aneurysmal hepatic arteries. Excision or obliteration of all hepatic artery aneurysms appears to be the management of choice. However, in managing aneurysms involving the proper hepatic artery and its extrahepatic branches, restoration of normal hepatic blood flow is most crucial. A 49-year-old man was found to have a huge extrahepatic artery aneurysm involving the area from the origin of the common hepatic artery to the distal proper hepatic artery. It ruptured into the duodenal bulb and firmly adhered to the surrounding structures including pancreas and common bile duct. Extended surgery with restoration of normal hepatic flow was performed safely. In cases with huge extrahepatic artery aneurysms, an aggressive approach to restore the hepatic arterial continuity seems appropriate for the prevention of ischemic damage to the liver.
Cho
Yong Pil
YP
Department of General Surgery, Gangneung Asan Hospital, 415 Bangdong-ri, Sacheon-myeon, Gangneung-si, Gangwon-do, Republic of Korea, 210-711. ypcho@knh.co.kr
Jang
Hyuk Jai
HJ
Kim
Seung Yong
SY
Lee
Deok Hee
DH
Lee
Sung Gyu
SG
D000714:Anastomosis, Surgical; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000601:surgery*; D000792:Angiography; D001027:Aortography; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000601:surgery*; D004381:Duodenal Ulcer / Q000000981:diagnostic imaging / Q000601:surgery; D004386:Duodenum / Q000098:blood supply*; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply*; D016577:Pancreaticoduodenectomy; D010438:Peptic Ulcer Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012501:Saphenous Vein / Q000637:transplantation; D014057:Tomography, X-Ray Computed