Abdominal bleeding in the presence of multiple intrahepatic aneurysms

A 17-year-old male patient presented with diffuse abdominal pain, acute drop in hemoglobin and free subhepatic fluid. The patient was transferred to our unit for investigation of presumed spontaneous hepatic bleeding. Questioning revealed daily medication of 2 g acetylsalicylic acid because of influenzal infection. At exploratory laparoscopy 1.8 l hematoma was removed; the origin of bleeding could not be identified. The liver surface appeared macroscopically unremarkable, with the exception of an aneurysmal dilatation of the cystic artery that was considered as possible bleeding cause. Postoperative angiography confirmed the presence of multiple aneurysmal dialatations of both left and right hepatic arteries. Extensive investigations did not show any further aneurysms or vascular abnormalities in any other part of the body. There was no evidence of a preexistent systemic vasculitis or primary collagen disease.