[Spontaneous rupture of an intrahepatic aneurysme: radiological and surgical treatments].

Spontaneous rupture of intrahepatic aneurysm is a rare life threatening condition because of the risk of spontaneous rupture. A 33 year old female patient presented with hemorrhagic shock. Angio-CT-scan revealed an intrahepatic ruptured aneurysm with a massive central and subcapsular haematoma of the liver. Percutaneous embolisation under ultrasound control was not possible because of the size of the subcapsular haematoma. Angiography showed a main arterial supply of this aneurysm from the anterior sectorial branch of the right branch of hepatic artery and selective embolisation was not possible because of anatomical configuration. Because of persistent bleeding, surgery was performed with evacuation of liver haematoma and a highly selective ligature of the main aneurysmal arterial supply. Post-operative angio-CT-scan showed revascularisation of the aneurysm through retrograde intrahepatic arterial supply. Ultrasound identification of the aneurysm was then possible and percutaneous embolisation was performed successfully. Intrahepatic aneurysms are usually treated by interventional radiological procedure. In case of failure, surgery should be considered. This case was original because it associated a combined therapeutic treatment pointing out the importance of multidisciplinary approach.