Life-Threatening Ruptured Hepatic Artery Pseudoaneurysm Post-Liver Transplant: A Case Report

• Published in: Transplantation proceedings 2024-06, Vol.56 (5), p.1092-1095
• Main Authors: Silva, Maciana Santos, Waisberg, Daniel Reis, Caldas, Tarsila Gomes, Martino, Rodrigo Bronze, Rocha-Santos, Vinicius, Pinheiro, Rafael Soares, Ducatti, Liliana, Arantes, Rubens Macedo, Alvarez, Jhosimar, Marin-Castro, Pedro, Vieira, Igor Ferreira, Almeida, Juliani Dourado, Carneiro-D'Albuquerque, Luiz Augusto, Andraus, Wellington
• Format: Article
• Language: English
• Subjects: Adult; Aneurysm, False - etiology; Aneurysm, False - surgery; Aneurysm, Ruptured - etiology; Aneurysm, Ruptured - surgery; Female; Hepatic Artery - diagnostic imaging; Hepatic Artery - surgery; Humans; Liver Transplantation - adverse effects; Postoperative Complications - etiology; Postoperative Complications - surgery; Reoperation; Tomography, X-Ray Computed
• ISSN: 0041-1345; 1873-2623; 1873-2623
• DOI: 10.1016/j.transproceed.2024.04.019

•Rupture of hepatic artery anastomotic pseudoaneurysm may be life-threatening.•Ligating the recipient's hepatic artery may be needed to control massive bleeding.•Retransplantation may be required in case of biliary complications. Hepatic artery pseudoaneurysm after liver transplantation is a rare condition that can lead to spontaneous bleeding, depending on its extent and location. Treatment involves endovascular and surgical approaches in addition to liver retransplantation in cases of graft failure. A 42-year-old female underwent deceased donor liver transplantation due to cryptogenic cirrhosis and schistosomiasis with an uneventful postoperative course. However, 18 days after the operation, she presented to the emergency department with abdominal pain, hypotension, and lipothymia. A computed tomography scan revealed a hepatic artery anastomotic pseudoaneurysm, and due to hemodynamic instability, emergency laparotomy was indicated. During the operation, the pseudoaneurysm was found to be ruptured, and the recipient's hepatic artery was ligated due to life-threatening bleeding. She later developed ischemic cholangiopathy and biliary complications, eventually undergoing retransplantation 7 months after the emergency operation. The patient remains well 11 months after the retransplantation. We report a rare case of life-threatening rupture of hepatic artery pseudoaneurysm, which required emergency ligation of the recipient's hepatic artery and subsequent liver retransplantation due to biliary complications.