Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2016; 8(6): 467-471
Published online Jun 27, 2016. doi: 10.4240/wjgs.v8.i6.467
Gastrointestinal bleeding and obstructive jaundice: Think of hepatic artery aneurysm
Fabrice Vultaggio, Pierre-Henri Morère, Christophe Constantin, Michel Christodoulou, Didier Roulin
Fabrice Vultaggio, Michel Christodoulou, Didier Roulin, Service de Chirurgie Générale, Hôpital du Valais, 1950 Sion, Switzerland
Pierre-Henri Morère, Christophe Constantin, Département d’Imagerie Médicale et Radiologie Interventionnelle, Hôpital de Sierre, 1950 Sion, Switzerland
Michel Christodoulou, Service de Chirurgie, Hôpital de Sierre, 3960 Sierre, Switzerland
Author contributions: Vultaggio F, Christodoulou M and Roulin D designed the report; Morère PH and Constantin C performed the micro-embolization; Vultaggio F and Roulin D collected and analyzed the patient’s clinical data, and wrote the paper; all authors critically reviewed the paper.
Institutional review board statement: The study was reviewed and approved by the Commission Cantonale Valaisanne d’Ethique Médicale, Hôpital du Valais Institutional Review Board.
Informed consent statement: The patient provided written informed consent prior to study.
Conflict-of-interest statement: The authors swear not to present any conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michel Christodoulou, MD, Service de Chirurgie, Hôpital du Valais, Rue St-Charles 14, 3960 Sierre, Switzerland. michel.christodoulou@hopitalvs.ch
Telephone: +41-27-6037521 Fax: +41-27-6037523
Received: March 4, 2016
Peer-review started: March 7, 2016
First decision: March 22, 2016
Revised: April 4, 2016
Accepted: April 14, 2016
Article in press: April 15, 2016
Published online: June 27, 2016
Abstract

Hemobilia is an uncommon and potential life-threatening condition mainly due to hepato-biliary tree traumatic or iatrogenic injuries. Spontaneously ruptured aneurysm of the hepatic artery is seldom described. We report the case of an 89-year-old woman presenting with abdominal pain, jaundice and gastrointestinal bleeding, whose ultrasound and computed tomography revealed a non-traumatic, spontaneous aneurysm of the right hepatic artery. The oeso-gastro-duodenoscopy and colonoscopy did not reveal any bleeding at the ampulla of Vater, nor anywhere else. Selective angiography confirmed the diagnosis of hepatic artery aneurysm and revealed a full hepatic artery originating from the superior mesenteric artery. The patient was successfully treated by selective embolization of microcoils. We discuss the etiologies of hemobilia and its treatment with selective embolization, which remains favored over surgical treatment. Although aneurysm of the hepatic artery is rare, especially without trauma, a high index of suspicion is needed in order to ensure appropriate treatment.

Keywords: Hemobilia, Hepatic artery aneurysm, Obstructive jaundice, Supra-selective micro-embolization, Gastrointestinal hemorrhage

Core tip: Non-traumatic aneurysm of the hepatic artery leading to hemobilia as the source of gastrointestinal bleeding may be subtle to recognize, not only because of its low incidence but also because of its inconsistent clinical signs. These aneurysms are more commonly seen after a traumatic event on the biliary tree, however in rare cases, it occurs spontaneously, mainly in the settings of vascular degeneration and chronic gallbladder inflammatory disease. Moreover, the hepatic artery is known for multiple anatomical variants, some of which are rare. Our patient presented with both uncommon conditions and was successfully treated with micro-coils embolization.