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- W2977430908 abstract "Hepatic artery aneurysms (HAA) constitute 14-20% of visceral artery aneurysms. Most of the HAA are asymptomatic. Although rare, obstructive jaundice due to external bile duct compression or rupture of the HAA into the biliary tree with clots occluding the lumen, has been reported. 56 year old white male with history of COPD and HTN presented to an outside hospital with complaints of yellowing of skin, eyes, right sided abdominal pain and dark urine for. Laboratory work revealed WBC 9000/ cu mm, total bilirubin 24 mg/dl, ALP 1104 U/L,AST 200 U/L and ALT 236 U/L. CT abdomen and pelvis revealed intra and extra hepatic biliary dilatation with a hepatic artery aneurysm causing compression of the CBD. He was transferred to our hospital where he underwent an ERCP with cholangioscopy. This revealed a CBD stricture ˜ 2-3 cm long at the level of cystic duct takeoff, with massive biliary dilation proximally. Biopsies were obtained and a plastic stent was deployed traversing the stricture. Biopsies revealed inflammation. CT angiography with 3 D reconstruction was obtained which confirmed location of fusiform hepatic artery aneurysm compressing the CBD. Patient had remarkable improvement in symptoms as well as hepatobiliary chemistries- AST 59 U/L, ALT 52 U/L, ALP 239 U/L and total bilirubin 2 mg/dl, two week following the procedure. He then underwent coil embolization of the hepatic artery. Stent grafting could not be attempted secondary to discrepancy in the size of proximal(10mm) and distal(5mm) entry into the aneurysm. Patient tolerated the procedure well and was later discharged. Management of obstructive jaundice secondary to HAA depends on clinical presentation. Biliary stenting prior to surgical management of aneurysm, is usually attempted in patients without hemobilia. However risk of the stent entering the aneurysm and precipitating major hemorrhage must be considered. In patients with HAA presenting with abdominal pain, obstructive jaundice and hemobilia (Quinke's triad), biliary obstruction should be dealt with as part of the definitive excision of the aneurysm and repair of the damaged bile duct.Figure 1Figure 2Figure 3" @default.
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- W2977430908 date "2015-10-01" @default.
- W2977430908 modified "2023-09-27" @default.
- W2977430908 title "The Aftermath of a Hepatic Artery Aneurysm: A Rare Etiology of Biliary Obstruction" @default.
- W2977430908 doi "https://doi.org/10.14309/00000434-201510001-00200" @default.
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