Rupture of hepatic artery aneurysm associated with ischemic hepatitis Rotura de arteria hep芍tica aneurism芍tica asociada con hepatitis isqu谷mica

作者：V M Santos; R B Villaa; A C A Almeida; E R N C Oliveira

来源：Anales del Sistema Sanitario de Navarra, 2010.

• Rotura aneurismatica
• Arteria hepatica
• Hemoperitoneo
• Hepatitis isquemica
• Aneurysmal rupture
• Hepatic artery
• Hemoperitoneum
• Ischemic hepatitis

Hepatic artery aneurysms are scarcely reported, mainly because of non-specific symptoms. More often, they are incidental findings during imaging studies to investigate other acute or chronic abdominal conditions. These aneurysms are usually detected in the sixth decade of life, predominantly among males. We report the case of a 69 year-old female with an unsuspected huge hepatic artery aneurysm associated with ischemic hepatitis. Suspicion of aneurysm arose during imaging studies to clarify the origin of jaundice and abdominal pain. After establishment of the diagnosis, but before open surgery, there was a spontaneous rupture of the aneurysm, which caused hemoperitoneum and death. The necropsy study confirmed ischemic hepatitis. Hepatic artery aneurysms are second among the visceral aneurysms, and may cause abdominal pain, jaundice, and hemorrhagic events. One should suspect abdominal aneurysms in elderly patients with unclear abdominal pain, and this hypothesis should be ruled out by imaging studies. La publicaci車n de trabajos sobre aneurismas en la arteria hep芍tica es escasa, debido a los s赤ntomas no espec赤ficos y a que constituyen hallazgos incidentales durante investigaci車n de otras condiciones abdominales agudas o cr車nicas. Estos aneurismas son m芍s frecuentes en varones y en la sexta d谷cada de la vida. Presentamos el caso de una mujer de 69 a os de edad que ingresa en el hospital con un aneurisma de arteria hep芍tica no sospechado previamente, asociado con hepatitis isqu谷mica. La sospecha de aneurisma empez車 durante estudio de im芍genes para aclaramiento del origen de ictericia y dolor abdominal. Despu谷s de confirmado el diagn車stico, pero antes de la operaci車n planeada, ocurri車 rotura espont芍nea del aneurisma causando hemoperitoneo y muerte. El estudio de necropsia confirm車 hepatitis isqu谷mica. Los aneurismas de la arteria hep芍tica son los segundos entre los aneurismas viscerales y pueden causar dolor abdominal, ictericia y eventos hemorr芍gicos. Debemos sospechar de aneurisma visceral en ancianos con dolor abdominal no aclarada, posibilidad que debe ser descartada por estudios de im芍genes.