Liver resection in a patient with concomitant thoraco‐abdominal and cerebral aneurysms

Background.Surgical resection remains the only curative procedure for liver metastases but even in expert hands it has appreciable morbidity and mortality rates. The presence of a concomitant aortic aneurysm greatly increases these risks.Case outline.A 66‐year‐old woman who was known to have large aneurysms of the thoraco‐abdominal aorta and middle cerebral artery presented with colorectal liver metastases. After detailed preoperative assessment, she underwent resection of segments V and VI of the liver. The surgical procedure was uneventful. She made a good initial recovery, but on day 7 she suddenly became hypotensive and died from a cardiorespiratory arrest. Post‐mortem examination revealed a ruptured thoracic portion of the thoraco‐abdominal aortic aneurysm.Conclusion.Despite careful control of perioperative blood pressure and the lack of abdominal complication, intrathoracic aneurysmal rupture on day 7 highlights the risk of major unrelated operations in patients with aneurysmal disease.