Obstructive icterus directly related to visceral artery aneurysm in a CAPD patient.
Visceral artery aneurysms (VAA) are uncommon pathologies. We report a case of the first CAPD patient with obstructive jaundice directly related to VAA. A 25-year-old man with a four-year history of hemodialysis followed by two years of CAPD was admitted due to jaundice. He had two episodes of peritonitis. An abdominal ultrasonogram and a selective common hepatic arteriogram confirmed the presence of a 5 cm saccular aneurysm supplied from the gastroduodenal artery and a 4 cm fusiform aneurysm supplied from the proximal part of the common hepatic artery. The gastroduodenal artery was responsible for the impression of the common bile duct. In the operation, the gastroduodenal artery aneurysm was completely excised after its proximal and distal ends were ligated. The proximal and distal ends of the hepatic artery were also ligated. A prosthetic graft (PTFE), which extended from the splenic artery to the distal portion of the hepatic artery, was placed. In this way, the arterial blood flow of the liver was re-established. Patients with VAAs present with a constellation of symptoms including abdominal pain, jaundice and shock (due to rupture of aneurysm). Pancreatitis, and atherosclerosis have been reported to be the most common causes of VAAs. In conclusion, when CAPD patients present with jaundice or hemorrhagic shock with abdominal pain, VAA should be considered in differential diagnosis, especially if patients have a history of frequent pancreatitis episodes, and severe risk factors for atherosclerosis.
Sipahioglu
M H
MH
Department of Nephrology, Erciyes University Medical School, Kayseri, Turkey. murathsipahioglu@yahoo.com
Tokgöz
B
B
Karahan
O I
OI
Ok
E
E
Sav
T
T
Oymak
O
O
Utas
C
C
D000328:Adult; D000783:Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D000792:Angiography; D019917:Blood Vessel Prosthesis Implantation; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D007813:Laparotomy; D008297:Male; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography