PMC6077596_01
Computed tomography (CT) images. CT on admission (a) demonstrating liver cirrhosis with the greater omentum in the upper abdomen and tiny omental vessels (arrow) in the left upper abdomen. Arterial phase of contrast-enhanced computed tomography image six days later (b) with haemoperitoneum, segmental dilatated omental artery in the left (arrow), and spot of enhanced tiny omental artery in the right upper abdomen (small arrow).
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In doing so, scans of the upper parts of the abdomen demonstrated liver cirrhosis without ascites or additional pathologies and with the greater omentum positioned almost entirely in the upper abdomen (Figure 1(a)). Spots of enhanced tiny vessels also were visible in the right upper abdomen ventral to the liver (Figure 1(b)).
Digital subtraction angiograms. Common hepatic arteriogram (a) with the right gastroepiploic artery forming the omental arch (arrow) and two small right omental branches with multisegmental dilatation (small arrows), better visible in the late phase (b).
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These revealed an anatomic variant with absence of the left gastroepiploic artery (left gastroomental artery), the gastroepiploic arch being exclusively formed by the right gastroepiploic artery (right gastroomental artery), and consecutively a separate origin of the LOA (left omental branch) from an inferior pole splenic artery (Figures 2 and 3). Additionally, two tiny omental branches of the right gastroepiploic artery with small multisegmental dilatation and a typical "wind-sock" formed aneurysm of the LOA were visible (Figures 2 and 3).
Digital subtraction angiograms. Splenic arteriogram (a) with a markedly dilatated segment, respectively, spindle-shaped aneurysm (arrow) of the left omental artery (LOA), better visible in the late phase (b) and with separate origin of the LOA from an inferior splenic pole artery. Superselective arteriogram of the LOA (c) before embolization (noteworthy, the tortuous microcatheter in the substantially elongated splenic artery). Postembolization arteriogram of the splenic artery demonstrating NBCA-casting and stasis of the LOA (arrow) with preserved splenic arteries (d).
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These revealed an anatomic variant with absence of the left gastroepiploic artery (left gastroomental artery), the gastroepiploic arch being exclusively formed by the right gastroepiploic artery (right gastroomental artery), and consecutively a separate origin of the LOA (left omental branch) from an inferior pole splenic artery (Figures 2 and 3). Additionally, two tiny omental branches of the right gastroepiploic artery with small multisegmental dilatation and a typical "wind-sock" formed aneurysm of the LOA were visible (Figures 2 and 3). The final DSA control confirmed the complete embolization of the aneurysm of the LOA with preservation of the splenic vessels (Figure 3).