2025 Volume 45 Issue 7 Pages 640-643
A 57-year-old woman who presented with sudden-onset abdominal pain was transferred to our hospital. Contrast-enhanced abdominal CT revealed a 30-mm aneurysm in the left hepatic artery, along with a suspected hematoma within the hepatoduodenal ligament. The left portal vein branch was compressed by the aneurysm, although contrast enhancement of the left hepatic lobe was preserved. We initially planned endovascular intervention, based on a diagnosis of ruptured left hepatic artery aneurysm. However, portal venography showed significantly reduced flow in the left portal venous branch, raising concern about possible development of hepatic infarction if embolization was performed; therefore, we selected surgical intervention instead. Intraoperative exploration revealed the hepatic artery aneurysm localized around the umbilical portion of the portal vein and hemorrhagic ascites beneath the liver. Intraoperative ultrasound confirmed reduced portal blood flow due to compression by the aneurysm. We resected the hepatic aneurysm and confirmed restoration of the portal flow. Although endovascular intervention is generally regarded as the gold standard for hepatic artery aneurysms, surgical resection could be a promising option in cases found to show reduced portal venous flow, to prevent hepatic ischemia.
