Obstructive jaundice caused by a giant common hepatic artery aneurysm

A 92-year-old woman was referred to our hospital for the evaluation of progressive jaundice. Laboratory findings showed cholestatic liver dysfunction (total bilirubin, 7.14 mg/dL; direct bilirubin, 4.98 mg/dL; aspartate aminotransferase [AST], 158 U/L; alanine aminotransferase [ALT], 150 U/L; alkaline phosphatase [ALP], 467 U/L; and gamma-glutamyl transpeptidase [γ-GTP], 262 U/L). Contrast-enhanced computed tomography (CECT) revealed a bilobed aneurysm >70 mm in diameter arising from the common hepatic artery (Fig. 1A–C). The aneurysm compressed the extrahepatic bile duct, causing obstructive jaundice without stones or malignancy (Fig. 1A, B). Angiography revealed a large saccular aneurysm near the proximal common hepatic artery (Fig. 1D). However, the inflow route could not be identified, making embolization technically unfeasible. Because of the size and rupture risk of the aneurysm, endoscopic procedures, such as endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography, were avoided. Strict blood pressure control was initiated and jaundice improved within several days, likely because of decreased compression. Liver enzyme levels improved steadily, and had normalized (total bilirubin, 0.91 mg/dL; AST, 24 U/L; ALT, 22 U/L; ALP, 159 U/L; γ-GTP, 85 U/L) 3 weeks later. Follow-up CECT after 5 weeks (Fig. 2) showed a slight shrinkage of the aneurysm from 70 to 64 mm, accompanied by an improvement in bile duct dilatation.

Fig. 1.

Contrast-enhanced computed tomography (CECT) and angiographic findings of a giant common hepatic artery aneurysm. Coronal (A) and axial (B) CECT images showing a bilobed aneurysm >70 mm in diameter arising from the common hepatic artery and compressing the extrahepatic bile duct without stones or malignancy. (A) The site of biliary compression is indicated by a white arrow. (C) Three-dimensional computed tomography (CT) reconstruction showing the giant aneurysm. (D) Angiography of the celiac artery reveals a large saccular aneurysm near the proximal common hepatic artery, with an indistinct inflow route owing to its size.

Fig. 2.

Follow-up contrast-enhanced computed tomography obtained 5 weeks after the initial examination. Coronal (A) and axial (B) images show slight shrinkage of the common hepatic artery aneurysm (from 70 to 64 mm).

Because of the patient’s age, comorbidities, and recovery, no further invasive management (surgical repair, endovascular stent graft, or other alternatives) was attempted with informed consent, and she was discharged with close outpatient follow-up.

Hepatic artery aneurysms are rare, comprising 14% to 20% of visceral artery aneurysms.1,2 Although rupture is the most serious complication, obstructive jaundice caused by extrinsic compression is extremely uncommon.3 This case highlights the need to consider visceral artery aneurysms as an unusual cause of obstructive jaundice and supports conservative management as a viable option in selected elderly patients.