Ruptured Hepatic Artery Aneurysm in a Child

Abstract

Hepatic artery aneurysm is a rare clinical and pathological entity. Although the condition is most frequently discovered as an incidental finding at autopsy, it often presents a difficult diagnostic challenge. The classical triad of abdominal pain, hemobilia and jaundice is rarely seen. Occasionally, patients present with acute abdominal catastrophe due to rupture of the aneurysm into the peritoneal cavity.1 It may not be possible for the diagnosis to be made preoperatively, except at emergency laparotomy.2 We report the case of a seven-year-old boy who presented with acute abdominal pain, jaundice and hemoperitoneum, leading to hypovolemic shock, which required urgent laparotomy and confirmed the rupture of the hepatic artery aneurysm. Case ReportA seven-year-old Saudi boy who had global developmental delay secondary to brain dysgenesis was admitted to King Faisal Specialist Hospital and Research Centre, Riyadh, with a two-day history of abdominal pain, fever and jaundice. The family reported no previous history of trauma, and nor was there any history of joint, skin, or systemic involvement or gastrointestinal bleeding. The patient's physical examination showed a sick-looking child with mild dehydration. He was pale and jaundiced, and his temperature was 39°C. He had a blood pressure of 110/60 mm Hg, heart rate of 90/minute, and respiratory rate of 20/minute. He had a distended abdomen with marked tenderness, as well as rebound tenderness and ascites at the right upper hypochondrium. Bowel sounds were audible and there was no organomegaly. The rest of the systemic examination was normal.Laboratory studies showed white blood cell count of 9.9x109/L, hemoglobin of 8.1 g/dL, reticulocyte count of

Ruptured aneurysm of the hepatic artery: a mismatching diagnosis

“…Hepatic artery aneurysms are rare clinical-pathological entities, most often discovered as an incidental finding at autopsy. Patients are often asymptomatic and late presentation may represent a difficult diagnostic challenge in emergency medical practice [1,2].…”