Ruptured hepatic artery aneurysm precipitated by gangrenous perforated appendicitis: A case report

Introduction Hepatic artery aneurysms are among the most common visceral artery aneurysms although still relatively rare. Repair of aneurysms greater than 2 cm in diameter is important due to the high rate of rupture and associated mortality. Here we present a case of a sudden rupture of a hepatic artery aneurysm after presentation with a perforated gangrenous appendicitis. There is increasing evidence that expansion and rupture of abdominal aortic aneurysm is related to degradation of elastin and collagen by matrix metal-loproteinases. Elastin degradation leads to expansion whilst collagen degradation leads to rupture. Additionally , matrix metalloproteinases activity has been shown to be upreg-ulated by both sepsis and peritonitis. Case report An 80-year-old Caucasian man presented as an emergency with a 7-day history of central abdominal pain that had moved to the right iliac fossa and increased in severity over the last 2 days. His admission chest radio-graph was unremarkable. A diagnosis of acute appendicitis was made and the patient was booked at 01:00 for a laparoscopy and appendicectomy on the emergency list the following morning. The patient required a total of 11 units of packed red cells. He made a slow but uneventful recovery and was discharged 19 days later.