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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.A 65-year old male was admitted to surgical casualty with symptoms and signs of acute intestinal obstruction. He has been a toddy drinker for more than twenty years. Distended small and large bowel shadows were noted on the supine abdominal x-ray and inflammatory markers were elevated in blood. He underwent emergency laparotomy; descending colon and proximal part of sigmoid colon were found to be necrotic, with multiple perforations and a loculated abscess in the left paracolic gutter. The necrotic bowel loops were resected and the viable distal sigmoid colon was closed and an end colostomy was created.Macroscopically, specimen consisted of pieces of large bowel, measuring up to 15 cm in length and 6 cm in diameter, with patchy areas of full-thickness soft, white necrosis of the wall, ulcers with necrotic material adherent to their bases and large perforations (Figure 1). The ulcers were typically flask shaped, with a narrow neck and broad, undermined base. Microscopically, the affected bowel wall showed ischaemic necrosis with a mixed inflammatory cell infiltrate and small clusters of dispersed amoebic trophozoites (Figure 2 and 3). Periodic Acid Schiff staining was positive. The necrosis was transmural in the areas of perforation, and amoebic trophozoites were also seen within the lumen of blood vessels.

Introduction & importance Hepatic artery aneurysms (HAA) are rare and it accounts 20% of all visceral artery aneurysms. Commonly HAAs are autopsy findings, but rupture and bleeding carrying significant morbidity and can manifest as haemobilia. Case presentation A 63-year-old Sri Lankan male presented with severe melaena upper abdominal pain and features of obstructive jaundice was found to have a giant pseudoaneurysm at the right hepatic artery with the possible arterio-biliary fistula. The etiology for the pseudoaneurysm was not identified. Despite massive transfusion, the patient died before the endovascular intervention. Clinical discussion Atherosclerosis is the leading cause of HAA formation but can be associated with connective tissue disorders and arteritis. Most of the HAA are asymptomatic. Aneurysms can be managed with surgical or endovascular interventions. Conclusion Life-threatening haemobilia is a notorious complication of the rapture of HAA into the biliary system. The incidents of hepatic artery aneurysms and pseudoaneurysms due to percutaneous transhepatic interventions and minimal invasive hepatobiliary surgeries are in the rising trend. Nonleaking VAA can be best treated with endovascular treatment. The knowledge on this topic is important for the early detection and intervention of this rare entity.

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