Hepatic Artery Aneurysm Associated with Prune Belly Syndrome: A Case Report and Review of the Literature

Alhawsawi, Abdulelah; Aljiffry, Murad; Walsh, Mark; Peltekian, Kevork M.; Molinari, Michele

doi:10.1016/j.jsurg.2008.10.004

Cited by 15 publications

(18 citation statements)

References 28 publications

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“…Pseudoaneurysms should be differentiated from extrahepatic aneurysms. Histopathological fi ndings have shown that up to 50 % of HAAs are pseudo-aneurysms (1). This high rate is a natural result of the widespread and increasing usage of invasive percutaneous procedures, as well as of LCs, which can cause damage to the hepatic artery wall.…”

Section: Discussionmentioning

confidence: 99%

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Management of hepatic artery aneurysms

Polat¹,

Yb²,

Ercan³

et al. 2012

BLL

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Abstract:Background: Hepatic artery aneurysm (HAA) is a rare clinical entity that can lead to potentially life threatening complications. We reported our personal experience of 4 cases, in which we used different procedures. Methods: The fi rst case had a pseudo-aneurysm involving the right hepatic artery. The second case had a pseudoaneurysm, which was localized distal to the accidentally ligated right hepatic artery from the previous cholecystectomy operation. The third case had multiple aneurysms with accompanying dissecting abdominal aortic aneurysm. The fourth case had a pseudo-aneurysm originating from the proper hepatic artery. A covered stent was successfully placed in the case 1. In the second case, the right hepatic artery was ligated distal to the aneurysm. In the third case, vascular structures were not appropriate for vascular reconstruction, and a covered stent placement and embolization were unsuccessful. In the fourth case, ligation of the proper hepatic artery and cholecystectomy was performed.Results: The third case with multiple aneurysms died from multi-organ failure due to sepsis. The remaining cases (case 1, 2, and 4) are disease free and alive. Conclusion: HAAs are more commonly observed clinical entities, and their treatment should be handled for each patient separately. Computerized tomography-Angiography and intraoperative Doppler ultrasound are useful radio-diagnostics for determination of aneurysm and planning the operative procedure (Fig. 5, Ref. 15). Full Text in PDF www.elis.sk.

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Section: Discussionmentioning

confidence: 99%

“…Hypertension is the most common co-morbid disease followed by malignancy, peptic ulcer disease, peripheral artery disease, obesity and chronic obstructive pulmonary disease. There seems to be a strong association with tobacco and alcohol consumption (1).…”

mentioning

confidence: 99%

Management of hepatic artery aneurysms

Polat¹,

Yb²,

Ercan³

et al. 2012

BLL

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“…To the best of our knowledge, there are only three reports describing hepatic artery aneurysms associated with endocarditis reported in the English language literature since 1950 [11][12][13]. Both blunt and penetrating trauma and atherosclerosis are implicated in the majority of cases, while other rarer associations include polyarteritis nodosa, Marfan's syndrome, prune belly syndrome, cholecystitis and pancreatitis [14,15].…”

Section: Discussionmentioning

confidence: 99%

Multiphase multidetector CT in the diagnosis of haemobilia: a potentially catastrophic ruptured hepatic artery aneurysm complicating the treatment of a patient with locally advanced rectal cancer

Mortimer

Wallis²,

Planner³

2011

BJR

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ABSTRACT. Acute haemobilia is an unusual and potentially catastrophic cause of gastrointestinal bleeding. We describe such a case presenting as a rare complication of a hepatic artery aneurysm following the development and successful treatment of subacute bacterial endocarditis during a radical downstaging chemoradiotherapy regime for locally advanced rectal cancer. We suggest that multiphase multidetector-row CT can have an important role in the diagnosis of acute haemobilia and discuss imaging findings associated with the condition. This case raises awareness of benign conditions mimicking malignancy in oncological patients and reinforces the importance of reviewing historical imaging. Multidetector-row CT (MDCT) can have an important role in the diagnosis and management of acute haemobilia, an unusual and potentially catastrophic cause of gastrointestinal bleeding. We describe the rare complication of a hepatic artery aneurysm following the development and successful treatment of subacute bacterial endocarditis during a radical down-staging chemoradiotherapy regime for locally advanced rectal cancer. This case raises awareness of benign conditions mimicking malignancy in oncological patients and reinforces the importance of reviewing historical imaging. Case reportA 51-year-old male presented with colicky abdominal pain, haematemasis and maleana with hypotension. He had been diagnosed 14 months before with locally advanced rectal cancer. He had chemoradiotherapy and was due to undergo a radical proctectomy and sacralectomy. Unfortunately, the chemoradiotherapy regimen was complicated by severe mitral valve regurgitation secondary to subacute bacterial endocarditis (SBE). This was initially treated with antibiotics, but he went on to require a metallic mitral valve replacement and commenced longterm warfarin therapy. Following recovery from cardiac surgery, a restaging CT and an 18 FDG positron emission tomography (PET)-CT both only confirmed local disease spread and did not show evidence of metastatic disease.He presented acutely 3 months later with shock and anaemia, with a haemoglobin level of 6 g dl 21 and an international normalised ratio of 3.8. He required resuscitation, blood transfusion and reversal of coagulation. An emergency upper gastrointestinal endoscopy demonstrated no active bleeding with altered blood seen within the stomach and duodenum, but no specific bleeding point could be established. He remained haemodynamically unstable and underwent an emergency laparotomy, but again no specific bleeding point was established. The patient then underwent a triple phase MDCT of the liver to identify the source of the haemorrhage (Figure 1 and 2). This showed high density within the biliary tree consistent with acute haemorrhage and a small elliptical area in the inferior aspect of segment eight of the liver of mixed attenuation with a contrast blush on arterial phase that persisted and was more prominent on portal venous phase images.In view of the patient's background history of locally advanced malig...

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“…Other concurrent anomalies such as omphalocele, cardiac anomalies and hepatic artery aneurysm were also reported with this syndrome in the literature (15)(16)(17). The association of these anomalies with intra-abdominal pressure increase has not been fully demonstrated so it is difficult to explain the pathogenesis with the obstructive phenomena theory and they seem to support the second theory.…”

Section: Dıscussıonmentioning

confidence: 99%

Colonic lipomas mimicking colon cancer

Aytaç¹,

Yerci²,

Gürel³

et al. 2010

TJPATH

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Objective: Prune-belly syndrome is a rare congenital disorder characterized by musculature deficiency in the abdominal wall, lower urinary tract obstruction, other urinary tract anomalies, and bilateral cryptorchidism. The syndrome is commonly associated with pulmonary, skeletal, cardiac, and gastrointestinal defects. Over 95% of patients are male. Urinary tract disease is the major prognostic factor with the complications of pulmonary hypoplasia and end stage renal disease. The aim of this study was to determine phenotypic and pathologicalfeatures of fetuses with this syndrome. Material and Method:Six fetuses with prune-belly syndrome were evaluated by postmortem pathological investigation. Characteristic features of the fetuses with this syndrome as well as additional anomalies were evaluated.Results: Five fetuses were male while one was female. Gestational age ranged from 15 to 22 weeks. A urethral pathology that prevented urinary outflow from the bladder was present in all cases. Marked bladder distension with atrophy of the bladder smooth muscle and abdominal distension with muscular atrophy were also seen in all. Crypto-orchidism, Potter face, pes equinovarus, pulmonary hypoplasia and obstructive renal dysplasia were among the additional noteworthy anomalies. Conclusion:The pathogenesis of prune-belly syndrome is controversial. More studies are required on the inheritance, etiology and pathogenesis of the prune belly syndrome. Factors affecting the bilaminar and trilaminar germ layer during early 2-3. embryonic week may be considered to explain the pathogenesis of the anomalies seen with this syndrome.

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Hepatic Artery Aneurysm Associated with Prune Belly Syndrome: A Case Report and Review of the Literature

Cited by 15 publications

References 28 publications

Management of hepatic artery aneurysms

Management of hepatic artery aneurysms

Multiphase multidetector CT in the diagnosis of haemobilia: a potentially catastrophic ruptured hepatic artery aneurysm complicating the treatment of a patient with locally advanced rectal cancer

Colonic lipomas mimicking colon cancer

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