A Case of Left Hepatectomy for a Ruptured Intrahepatic Pseudoaneurysm with Portal Vein Thrombosis

Abstract

The patient was an 86-year-old woman who was admitted to another hospital with a diagnosis of acute cholecystitis and acute cholangitis. She had repeated biliary hemorrhages and was referred to our hospital. Contrast-enhanced computed tomography and angiography showed a ruptured intrahepatic pseudoaneurysm with portal vein thrombosis. Endovascular treatment of the hepatic aneurysm was considered to prevent rebleeding, but it was not performed because of the risk of hepatic ischemia due to insufficient portal vein and hepatic artery blood flow. Left hepatectomy was performed after obtaining the patient's consent. Postoperatively, abscess formation was observed on the dissected surface of the liver, but the patient was discharged from the hospital on the 49th postoperative day after treatment with antibacterial drugs and drainage. Hepatic aneurysms occur infrequently, and ruptures are potentially fatal, requiring the selection of an appropriate treatment strategy. Although endovascular treatment has been widely used in recent years, there is no clear treatment strategy for hepatic aneurysms with portal vein thrombosis because of the risk of hepatic ischemia due to occlusion of the hepatic artery. This case is reported along with a review of the literature.