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• W3094623527 abstract "INTRODUCTION: The right hepatic artery (RHA) is a terminal branch of the celiac trunk and is the sole arterial supply to the right lobe of the liver. When the hepatic artery arises from a source other than the terminal end of the celiac trunk, it is considered an aberrant hepatic artery and is present in up to one-third of all cases. This case describes a patient with a history of carcinoid lung tumor presenting with a soft tissue mass compressing the superior mesenteric artery (SMA) that resulted in mesenteric ischemia as well as ischemic hepatitis due to the presence of an aberrant RHA. This unique clinical scenario has not been demonstrated in literature review. CASE DESCRIPTION/METHODS: A 60 year old male with a medical history of carcinoid tumor of the right lung on chemotherapy presents to the hospital for postprandial generalized abdominal pain. A CT of the abdomen and pelvis revealed new findings of narrowing of the SMA with an adjacent soft tissue mass measuring 11 × 15 mm with mural thickening of the artery. Patient noted to have a lactate of 16.6 with a total bilirubin of 1.4, AST/ALT of 3517/1593, PT/INR of 42.7/3.81 and a BUN/creatinine of 60/3.2. Patient was initially accepted to a large hepato-biliary center for evaluation, however patient’s condition rapidly deteriorated requiring emergent dialysis, mechanical ventilation and vasopressor support and transfer was rescinded. Patient had angioplasty done that revealed severe diffuse vaso-constriction of all visualized mesenteric vessels and 80% smooth stenosis of the proximal SMA 1 cm from the origin and received successful proximal SMA stent placement. Patient also had an emergent exploratory laparotomy that showed viable dilated bowel with no ischemic changes as well as an aberrant RHA arising directly from the SMA. Although patient’s laboratory values improved after SMA stent placement including AST/ALT, INR and lactate, patient’s hospital course was complicated by prolonged mechanical ventilation requiring eventual tracheostomy and PEG tube placement with transfer to LTAC. DISCUSSION: This case illustrates the importance of recognizing atypical anatomy as a source of ischemic hepatitis in patients whom typical sources of shock liver are ruled out. Additionally, the knowledge of such anomalies is significant since their awareness will decrease morbidity and help prevent complications. Especially since anatomical variations of the right hepatic artery contribute to major intra-operative difficulties in hepato-biliary surgery.Figure 1.: Narrowing of the SMA with an adjacent soft tissue mass measuring 11 × 15 mm with mural thickening of the artery.Figure 2.: Narrowing of the SMA with an adjacent soft tissue mass measuring 11 × 15 mm with mural thickening of the artery.Figure 3.: Narrowing of the SMA with an adjacent soft tissue mass measuring 11 × 15 mm with mural thickening of the artery." @default.
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• W3094623527 date "2020-10-01" @default.
• W3094623527 modified "2023-09-25" @default.
• W3094623527 title "S2431 Aberrant Right Hepatic Artery Originating From the SMA Leading to Concurrent Acute Mesenteric Ischemia and Ischemic Hepatitis With Liver Failure" @default.
• W3094623527 doi "https://doi.org/10.14309/01.ajg.0000711772.59053.5d" @default.
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