Title:Intrahepatic Pseudoaneurysm Developing at the Confluence of Bilateral Biliary
Drains Six Months Following a Procedure- A Case Report
Volume: 20
Author(s): Izzeddin Qtaish, Mohammad Ayasrah*Noat R. Qtaish
Affiliation:
- Department of Allied Medical Sciences-Radiologic Technology, Faculty of Applied Medical Sciences, Jordan University of Science and Technology,
Irbid, Jordan
Keywords:
Hepatic artery aneurysm, Pseudoaneurysm, Percutaneous biliary drainage, Epigastric pain, liver injury, Gastric endoscopy.
Abstract:
Background:
Hepatic artery aneurysms (HAAs) exhibit a notable risk of rupture, with both true aneurysms and pseudoaneurysms being exceptionally
uncommon (incidence rate approximately 2 per 100,000). Symptoms include epigastric and right upper quadrant pain, jaundice, and potentially
life-threatening bleeding upon rupture. This bleeding can extend into the portal vein, hepatic vein, biliary system, or abdominal cavity. While
existing literature lacks reports of delayed post-therapeutic complications, this case report discusses a 27-year-old female who developed a
pseudoaneurysm six months after bilateral biliary drain insertion, underscoring the potential for delayed complications.
Case Presentation:
The patient underwent gastric endoscopy revealing an extensive lower esophageal varix protruding into the proximal stomach, subsequently treated
with banding. The stomach and duodenum were found to contain fresh blood and blood clots indicating acute bleeding.
An urgent CT scan identified active bleeding (extravasation) at segment V and blood accumulation at the confluence of the right and left biliary
drains. This was followed by celiac and selective hepatic digital subtraction angiography (DSA).
Conclusion:
This case study outlines the occurrence of a hepatic artery pseudoaneurysm six months after percutaneous insertion of bilateral biliary drains. The
pseudoaneurysm manifested precisely at the confluence of the right and left drains. The reported delayed complication may have resulted from
friction between the drains at the confluence or erosion of the adjacent artery by the drains. The insights gained from this case shed light on the
causes and preventive measures for potential delayed complications associated with percutaneous biliary drain placement.
