Psuedoaneurysm of the right hepatic artery: a rare cause of obscure GI bleeding

ABSTRACT

A 63 years old female with 1 month history of hematemesis and malena, severe weakness and lethargy, for which she had upper GI endoscopies multiple times, but the source of bleeding could not be identified. Base line investigations revealed Hb of 6.0g/dl. CT scan abdomen showed cholelithiasis with air inside the gallbladder. The selective celiac axis / Hepatic artery angiogram revealed a right hepatic artery aneurysm [pseudoaneurysm]. After resuscitation with blood transfusion and fluids, the patient under went surgical exploration, revealing an aberrant right hepatic artery aneurysm bleeding inside the gall bladder with a cholecystodeudenal fistula [Mirrizi type III] into the 1st part of the deudenum form where the blood was leaking into the gastrointestinal tract and causing severe hematemesis and malena. A cholecystectomy, dissection of sleeve of liver bed, ligation of the aneurysmal bleeding vessel, repair of the cholecystodendenal fistula and placement of the T-Tube done. Post operative the patient remained stable and was discharged on 7th post operative day. Biopsy revealed acute on chronic cholecystitis and cholelithiasis. Biopsy of the aneurysmal wall revealed inflamed granulation tissue