Ruptur eines Aneurysmas der A. hepatica communis mit Pankreasnekrose

Rupture of an aneurysm of the common hepatic artery in the presence of pancreatic necrosis

Abstract

A male patient known to have hemophilia A was operated on twice (1990, 1991) in the Department of Surgery, University Hospital, Zürich, first because of severe intraabdominal hemorrhage from a liver artery aneurysm, and then because of a ruptured common hepatic artery aneurysm. The second surgical intervention revealed necrosis of the head and body of the pancreas. We consider that the pancreatic necrosis had resulted from the aneurysm, in view of the patient's history of silent panereatitis and the uncomplicated postoperative course. Immediate reconstruction of the common hepatic artery aneurysm (in the presence of an occluded gastroduodenal artery) was performed with saphenous vein interposition. Because visceral aneurysms may be multiple, further aneurysms must be sought at the time of the first diagnosis. Elective surgery is the method of choice, because 40–80% of visceral aneurysms rupture spontaneously, with a high mortality rate. The mortality rate for elective surgery is now low.

Zusammenfassung

Ein männlicher Patient mit bekannter Hämophilie A und verschiedenen Blutungskomplikationen (Gelenke, Nieren) wurde 1990 und 1991 im Departement Chirurgie des Universitätsspitals Zürich, operiert, beim 1. Mal wegen einer intraabdominalen Massenblutung aus einem Leberarterienaneurysma, beim 2. Mal wegen eines rupturierten Aneurysmas der A. hepatica communis. Dieses wurde wegen der verschlossenen A. gastroduodenalis durch Anlegen eines V.-saphena-magna-Interponats überbrückt. Bei der Zweitoperation wurden gleichzeitig eine Pankreaskopf- und -korpusnekrose festgestellt. Aufgrund der negativen Pankreatitisanamnese und dem unkomplizierten postoperativen Verlauf wurde die Pankreasnekrose nicht als Ursache, sondern als Folge des A.-hepatica-Aneurysmas interpretiert. Weil viszerale Aneurysmen multipel vorkommen, muß bei der 1. Aneurysmadiagnose nach weiteren viszeralen Aneurysmen gesucht werden. Die elektive Operation ist die Methode der Wahl, da im Spontanverlauf 40–80% rupturieren und in der Folge meistens letal sind. Bei der elektiven Chirurgie ist die Letalität gering.

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Korrespondenz an: Dr. R. Hoffmann

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Hoffmann, R., Marincek, B., Roggo, A. et al. Ruptur eines Aneurysmas der A. hepatica communis mit Pankreasnekrose. Langenbecks Arch Chir 378, 12–16 (1993). https://doi.org/10.1007/BF00207988

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Key words

  • Hepatic artery aneurysm
  • Rupture
  • Necrosis of the pancreas
  • Hemophilia A