Aneurysms at any and every level of the vascular system have been reported worldwide with significant inroads made in the treatment modalities over the last two decades.At times the aneurysm is picked by a diagnostic modality done for a different cause.Aneurysms like the ones of the cealiac axis,hepatic artery,superior mesenteric artery etc are not very common to come across and may even go undiagnosed till some eventuality happens.Traumatic aneurysms/Pseudoaneurysms of the hepatic artery are still all the more rare to come across.Basically the age old saying that was taught to us when we were in medical schools still holds true"FIRST SURGERY IS THE BEST SURGERY".Preoperative diagnosis if the health of the patient permits and more importantly a thorough examination of the vicera and tissue during laprotomy becomes mandatory more so in traumatic cases so as not to miss any injury.
We report to you a case of large hepatic artery pseudoaneurysm tackled by us in the recent past.This guy met with a road traffic accident, underwent laprotomy and splenectomy was done.He had hepatic artery injury as well which went unnoticed.Patient recovered and was discharged only to come back with pain abdomen,swelling in the epigastrium and significant loss of apetite after 6 months.CT scan and angio were suggestive of large hepatic artery pseudoaneurysm compressing the adjacent structures.Interventional radiologist did attempt doing coiling for the lesion without success.The case was referred to me and we planned a relaprotomy for the patient to fix the lesion.
Redo surgeries are never easy and pose a pleasant challenge to the operating surgeons especially in cases like these.Anyways the pseudoaneurysm was excised in totality and the hepatic artery was repaired.Follow-up CT angio is fine and the patient is totally asymtomatic.
The idea of reporting this case is its rarity and the importance of a thorough check at the first laprotomy for the mortality operating hepatic aneurysms is still high going by the small data available on net.
