A CASE OF POSTOPERATIVE IMPENDING RUPTURED PSEUDOANEURYSM OF THE LEFT HEPATIC ARTERY

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We recently experienced a case of unresectable hepatocellular carcinoma (HCC), to which under laparotomy a double lumen balloon catheter (5Fr, Swan-Ganz) was surgically inserted into the proper hepatic artery through the gastroduodenal artery and the tip of the catheter was localized around the bifurcation of the right & left hepatic artery for intermittent hepatic arterial occlusion (IHAO) with infusion chemotherapy. And to this patient Penrose drain was inserted into the foramen of winslow.Postoperative course was good, but on the 6th postoperative day, massive bleeding from the Penrose drain was recognized. X-ray film on emergent angiography of the hepatic artery through the S-G catheter revealed intraabdominal bleeding from the 8 mm-sized pseudoaneurysm at the origin of the left hepatic artery. Hemostasis could be obtained by blood transfusion and administration of hemostatic drugs.This pseudoaneurysm of the left hepatic artery was thrombolized by the S-G catheter during a therapeutic period with IHAO. In conclusion only 6 cases of ruptured pseudoaneurysm of the hepatic artery have been reported at the light of literature in Japan and so ruptured pseudoaneurysm was thought to be a rare disease, but we must pay more careful attention to the diagnosis and treatment of it.
日本臨床外科学会の論文