RUPTURE OF AN ANEURYSM OF THE COMMON HEPATIC-ARTERY IN THE PRESENCE OF PANCREATIC NECROSIS

A male patient known to have hemophilia A was operated on twice (1990, 1991) in the Department of Surgery, University Hospital, Zurich, 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 pancreatitis 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.