Aortic and splanchnic artery aneurysms: Unusual causes of biliary obstruction – A retrospective cohort from literature

Abstract

Mechanical obstruction of the biliary tree and resultant stasis are the cornerstone of a spectrum of diseases ranging from biliary colic to fulminant cholangitis. Infrequently acquired abnormalities of the abdominal vasculature can lead to biliary obstruction. In 2010, we reported a case of acute cholangitis resulting from compression of extra hepatic bile duct by an abdominal aortic aneurysm (AAA). We subsequently conducted a follow up scoping review of literature to identify other cases of acquired abdominal arterial abnormalities resulting in biliary obstruction looking at their management and outcomes. The articles were independently reviewed by two of the authors and pertinent data was extracted. The data was divided on an anatomic basis into two groups: one with primary aortic pathology and one with splanchnic vessel pathology. We identified 39 cases of biliary obstruction secondary to acquired aortic or splanchnic vessel abnormalities; 16 were caused by AAAs and 23 by splanchnic vessels. The cases were managed via conservative, endoscopic, endovascular or open surgical options based on the available technology and expertise. Although uncommon, recognition of aortic and splanchnic arterial abnormalities as a potential cause of biliary obstruction is important as management entails not only cautious decompression of the biliary tree but also addressing the underlying vascular pathology. We recommend that extrinsic biliary compression by an aneurysm or pseudoaneurysm be considered among the differential diagnosis in patients presenting with biliary obstruction and a known lesion of the abdominal vasculature.

Unique case of abdominal aortic aneurysm causing obstructive jaundice and duodenal obstruction

“…After extensive literature search, we came across eight substantial case reports. 9–16 Tin et al 17 identified 39 cases of biliary obstruction secondary to acquired aortic or splanchnic vessel abnormalities; out of these 16 were caused by AAAs, it was found that both genders are equally affected, and mean age of presentation was in seventh and eight decade.…”

Hemosuccus Pancreaticus and Obstructive Jaundice: Two Rare Complications of Chronic Pancreatitis Treated by Arterial Embolization

“…Mechanic obstruction of the biliary tree by a pseudoaneurysm is a rarity. In 2017, Tin et al [16] conducted an extensive literature search identifying a total of 39 cases of biliary obstruction secondary to either aortic or splanchnic vessel abnormalities. Of these, 23 were caused by splanchnic arteries, most frequently by the hepatic artery, followed by the right hepatic artery and the gastroduodenal artery.…”

Unsuccessful Stent Graft Repair of a Hepatic Artery Aneurysm Presenting with Haemobilia: Case Report and Comprehensive Literature Review

“…Since endovascular approaches did not exist before 1994, only studies from then on were selected in order to take the choice of treatment into consideration. 5 Only papers written in English were included. First, studies were screened by title and abstract.…”