Accessory Right Hepatic Artery Pseudoaneurysm Resulting in Biliary Obstruction

Abstract

Introduction: Visceral pseudoaneurysms are prone to rupture and can cause mass effect on surrounding structures, with extrinsic compression on the biliary tree being a rare but challenging complication.

Case presentation: We report a case of a 48-year-old man with a history of alcohol excess who presented acutely unwell with jaundice. Imaging revealed a pseudoaneurysm of the accessory right hepatic artery extending into an adjacent pancreatic pseudocyst, leading to common bile duct compression. Successful management included pseudoaneurysm exclusion with a stent graft and concurrent alleviation of the biliary obstruction.

Conclusion: Managing pancreatic pseudocysts with biliary compression becomes complicated when an accompanying pseudoaneurysm is present, elevating the associated risk. In this case, stent graft exclusion of the pseudoaneurysm was the chosen approach to preserve arterial flow with potential for long-term patency. Delayed pseudoaneurysm diagnosis underscores the importance of comprehensive assessment in complex presentations, such as jaundiced alcoholic patients, where the possibility of pancreatitis episodes necessitates evaluation of the visceral vasculature for pseudoaneurysms.

Keywords: Biliary intervention; Cholangitis; Pancreatitis; Pseudoaneurysm; Stent graft.