PMC6033208_01
Contrast enhanced computed tomography showing a 6 cm common hepatic artery aneurysm and coeliac artery dissection.
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Computed tomography (CT) showed a 6 cm CHAA and dissection of the coeliac artery (Fig. 1).
(A) Common hepatic artery angiography showed only left hepatic artery arising from the aneurysm. (B) After TAE, coils were placed into the aneurysm sac, proximal and distal HA. The right hepatic artery was supplied by the right gastroepiploic artery.
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During angiography of the common hepatic artery, only the left hepatic artery (HA) arose from the aneurysm (Fig. 2A). Finally, the collateral arterial blood supply of the liver was assessed (Fig. 2B).
(A) Upper gastrointestinal endoscopy showing a common hepatic artery aneurysm-duodenal fistula following transarterial embolisation. (B) The fistula and aneurysm gradually shrank by post-operative day 30.
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However, upper gastrointestinal endoscopy revealed a CHAA-duodenal fistula (Fig. 3A). The fistula was gradually occluded (Fig. 3B) using proton pump inhibitor and antibiotic infusions.
(A) Plain abdominal radiography showing migrated coils in the duodenum and descending and sigmoid colon (arrow). (B) Upper gastrointestinal endoscopy showing the penetration and migration of the coils through the duodenal fistula.
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Plain abdominal radiography and upper gastrointestinal endoscopy demonstrated that the coils had penetrated the duodenum (Fig. 4).