Abstract
This report describes the complex surgical management of a proper hepatic artery aneurysm in a 77-year-old male patient. He was admitted to the clinic with alcohol intoxication, arterial hypotension, hypoglycemia, severe abdominal pain, and nausea. His medical history included bilateral cerebral arterial syndromes, coronary artery disease.
Computed tomography revealed a 2.8 cm aneurysm of the hepatic artery proper compressing the portal vein, along with a large hematoma (18×9 cm) extending between the stomach and pancreas, and splenic injury. Emergency multi-stage surgery included laparotomy, abdominal drainage, splenectomy, epicystostomy, and vascular reconstruction of the ruptured aneurysm. Three drainage tubes were placed.
Postoperative complications included acute respiratory failure, shock, renal and hepatic insufficiency, post-hemorrhagic anemia, and coagulopathy. The patient required intensive care, mechanical ventilation, hemotransfusions, vasopressor support, antibiotics, and gastroprotective therapy. Under nephrologist supervision, the patient showed gradual improvement in renal and liver function, hemodynamic stability, and correction of anemia. Extubation was performed on postoperative day 8, and after two weeks, the patient was transferred to the surgical department.
Hepatic artery aneurysms are rare and often asymptomatic, but pose a high risk of rupture and life-threatening bleeding. In this case, despite an APACHE II-predicted mortality rate of 82%, the patient responded well to treatment and showed steady recovery.
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