Luckhurst Casey M, Perez Chelsey, Collinsworth Amy L, Trevino Jose G
Casey M Luckhurst, Chelsey Perez, Jose G Trevino, Department of Surgery, Colleges of Medicine, University of Florida Health Science Center, Gainesville, FL 32610, United States.
World J Hepatol. 2016 Jun 28;8(18):779-84. doi: 10.4254/wjh.v8.i18.779.
Classically, hepatic artery pseudoaneurysms (HAPs) arise secondary to trauma or iatrogenic causes. With an increasing prevalence of laparoscopic procedures of the hepatobiliary system the risk of inadvertent injury to arterial vessels is increased. Pseudoaneurysm formation post injury can lead to serious consequences of rupture and subsequent hemorrhage, therefore intervention in all identified visceral pseudoaneurysms has been advocated. A variety of interventional methods have been proposed, with surgical management becoming the last step intervention when minimally invasive therapies have failed. The authors present a case of a HAP in a 56-year-old female presenting with jaundice and pruritis suggestive of a Klatskin's tumor. This presentation of HAP in a patient without any significant past medical or surgical intervention is atypical when considering that the majority of HAP cases present secondary to iatrogenic causes or trauma. Multiple minimally invasive approaches were employed in an attempt to alleviate the symptomology which included jaundice and associated inflammatory changes. Ultimately, a right hepatic trisegmentectomy was required to adequately relieve the mass effect on biliary outflow obstruction and definitively address the HAP. The presentation of a HAP masquerading as a malignancy with jaundice and pruritis, rather than the classic symptoms of abdominal pain, anemia, and melena, is unique. This presentation is only further complicated by the absent history of either trauma or instrumentation. It is important to be aware of HAPs as a potential cause of jaundice in addition to the more commonly thought of etiologies. Furthermore, given the morbidity and mortality associated with pseudoaneurysm rupture, intervention in identifiable cases, either by minimally invasive or surgical interventions, is recommended.
传统上，肝动脉假性动脉瘤（HAPs）继发于创伤或医源性原因。随着肝胆系统腹腔镜手术的普及，动脉血管意外损伤的风险增加。损伤后假性动脉瘤的形成可导致破裂及随后出血的严重后果，因此提倡对所有确诊的内脏假性动脉瘤进行干预。已经提出了多种介入方法，当微创治疗失败时，手术治疗成为最后的干预手段。作者报告了一例56岁女性的HAP病例，该患者表现为黄疸和瘙痒，提示为肝门部胆管癌。考虑到大多数HAP病例继发于医源性原因或创伤，该患者无任何重大既往病史或手术干预史却出现HAP的情况并不典型。采用了多种微创方法来缓解包括黄疸及相关炎症变化在内的症状。最终，需要进行右半肝三叶切除术以充分缓解肿块对胆管流出道梗阻的压迫作用，并明确处理HAP。HAP表现为伴有黄疸和瘙痒的恶性肿瘤，而非典型的腹痛、贫血和黑便症状，这种情况很独特。由于没有创伤或器械操作史，这种表现更加复杂。除了更常见的病因外，认识到HAPs是黄疸的潜在原因很重要。此外，鉴于假性动脉瘤破裂相关的发病率和死亡率较高，建议对可识别的病例进行干预，无论是通过微创还是手术干预。
