Palubinskas Saulius, Rasmussen Simon Ladefoged
Department of Gastrointestinal Surgery, Aalborg University Hospital, Denmark.
Department of Gastrointestinal Surgery, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark.
Int J Surg Case Rep. 2017;41:12-16. doi: 10.1016/j.ijscr.2017.08.067. Epub 2017 Oct 4.
True hepatic artery aneurysms (HAAs) are rare, and when complicated by gastrointestinal haemorrhage, it becomes an even rarer disease entity. The mortality is high and imaging may fail to provide the diagnosis. We present a case of a true hepatic artery aneurysm complicated by a fistula to the duodenum which was first recognised during surgery.
A 77-year-old man presented with upper gastrointestinal haemorrhage. Upper endoscopy revealed an ulceration in the duodenal bulb, which was refractory to endoscopic treatment. Computed tomography and angiography did not reveal the source of haemorrhage and as such, the diagnosis was delayed, until laparotomy was performed. Resection of the HAA and graft placement resulted in complete haemostasis.
True hepatic aneurysms communicating with the gastrointestinal tract have only been presented in case reports and short case series. Arteriosclerosis is a relatively common risk factor, but the underlying pathology is unknown. Meanwhile, gastrointestinal haemorrhage is a symptom of other, more common diseases in the gastrointestinal tract, and these factors, complicate the diagnostic workup.
In the case of treatment refractory duodenal haemorrhage, a visceral aneurysm should be considered. Even though angiography is performed, a HAA may remain undetected due to bleeding cessation. Improved computed tomography modalities could aid in the detection of gastrointestinal haemorrhage from HAAs, and ensure timely treatment by endovascular methods or surgery if the diagnosis is kept in mind in the initial evaluation.
真性肝动脉瘤（HAA）较为罕见，当并发胃肠道出血时，它就成为一种更为罕见的疾病实体。死亡率很高，影像学检查可能无法做出诊断。我们报告一例真性肝动脉瘤并发十二指肠瘘的病例，该病例在手术过程中首次被发现。
一名77岁男性因上消化道出血就诊。上消化道内镜检查发现十二指肠球部有溃疡，内镜治疗无效。计算机断层扫描和血管造影未发现出血源，因此诊断延迟，直到进行剖腹手术。切除肝动脉瘤并进行移植物植入后实现了完全止血。
与胃肠道相通的真性肝动脉瘤仅在病例报告和简短病例系列中有所描述。动脉硬化是一种相对常见的危险因素，但其潜在病理机制尚不清楚。同时，胃肠道出血是胃肠道其他更常见疾病的症状，这些因素使诊断检查变得复杂。
对于治疗难治性十二指肠出血，应考虑内脏动脉瘤。即使进行了血管造影，由于出血停止，肝动脉瘤仍可能未被发现。改进的计算机断层扫描方法有助于检测肝动脉瘤引起的胃肠道出血，并在初始评估中牢记诊断的情况下，确保通过血管内方法或手术及时进行治疗。
