Primary dissecting hepatic artery aneurysm in pregnancy
Introduction
Primary dissecting hepatic artery aneurysms, unaccompanied by aortic or other dissections (i.e., secondary dissection), have previously been reported in 12 cases only [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], none of which were associated with pregnancy. A combined aneurysm involving the coeliac and extending into the hepatic artery was however, described by Muller and Kim [9] in a lady presented with back pain after spontaneous abortion. We report the first case of pregnancy-related dissecting aneurysm of the main hepatic artery in which the rupture of the vessels has resulted in the death of a primigravida and her fetus.
Section snippets
Case report
A 32-year-old 32 weeks pregnant Caucasian primigravida was admitted to King's College Hospital, London, England on 20 September 1978 at 1445 h with sudden onset of upper abdominal pain since 1300 h. She had normal obstetric course and regular uterine contractions for the last fortnight. Her BP during the antenatal period ranged between 110/70 and 120/80. In 1975, she was admitted for correction of varicose veins of the leg and her BP was 130/70. She also had a previous history of urinary tract
Pathological findings
Postmortem examination showed a jagged tear of about 1.3×0.8 cm found in the common hepatic artery, 2.5 cm from its origin from the coeliac axis (Fig. 1). The tear led into a 3×2.5-cm cavity of clotted blood. Hemorrhage surrounded the hepatic artery and has dissected the vessels distally into the right lobe of the liver. The liver (1711 g) parenchyma was normal. There was a large quantity of clotted blood retroperitoneally spreading in all directions and approximately 2.5 l of blood in the
Discussion
Pregnancy-related primary dissecting aneurysms are rare and their rupture is associated with increased risk of foeto-maternal mortality [13], [14]. The lesion has been reported in several arteries including the aorta [14], [15], coronary [16], coeliac [9], splenic [17], middle colic [17], iliac [14], and in the present paper, in the hepatic artery.
There are two groups of factors which may explain the pathogenesis of arterial aneurysms in pregnancy; one is nonspecifically related to pregnancy
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Pregnancy and vascular liver disease
2015, Journal of Clinical and Experimental HepatologyCitation Excerpt :Fatal outcome of pregnancy has only been reported in one woman with massive post-partum hemorrhage, multi-organ failure in whom a peliotic liver was incidentally found at laparotomy.64 Concerning hepatic artery anomalies in pregnancy, there has been a single case report about a woman with fatal intraperitoneal hemorrhage caused by a ruptured aneurysm of the common hepatic artery at 32 gestation weeks.65 These reports being exceptional, no conclusion can be drawn concerning pregnancy in women with peliosis or hepatic artery anomalies.
Dissecting aneurysm of the hepatic artery caused by an isolated spontaneous celiac trunk dissection
2014, Annals of Vascular SurgeryCitation Excerpt :He was doing well at 48 months follow-up after the first operation, with an oral intake of 100 mg cilostazol daily. Spontaneous DHAA is rare, with only 26 patients reported.1–23 Of these reported cases, 21 were caused by primary HA dissection1–16,18–21,23 and 5 by ISDCA.1,8,16,17,22
Coil embolization of unusual aneurysm formation in a common hepatic artery
2011, European Journal of Radiology ExtraHepatic artery dissection in a 65-year-old woman with acute pancreatitis
2011, Annals of Vascular SurgeryDissection of hepatic artery aneurysm after gastrectomy
2008, Annales Francaises d'Anesthesie et de Reanimation