INTRODUCTION: The incidence of hepatic artery aneurysm has been on the rise due to the increasing numbers of imaging studies and hepatobiliary procedures being performed. While the vast majority of cases remain asymptomatic, those which present clinically are the ones which rupture.

CASE REPORT: Here is a 28 years old female patient, who was admitted with right hypochondrial pain, mild jaundice and fever. Magnetic resonance cholangiopancreaticography (MRCP) revealed a Type I choledochal cyst. Suspecting cholangitis, she was managed conservatively in the initial phase, later excision of the choledochal cyst, with cholecystectomy and hepaticojejunostomy was performed under general anaesthesia.

Intraoperatively there were no complications, patient recovered briskly,on eleventh post operative day, She suddenly developed abdominal pain in the right hypochondrium, associated with hypotension, tachycardia and abdominal distension. On investigation Haemoglobin level was 4.9gms. Suspecting an intraperitoneal bleed, USG abdomen was done which revealed haemoperitoneum. Immediate blood transfusion was done. After Stabilizing the patient, CT Abdominal Angiogram was done, It revealed an aneurysmal dilatation of the left hepatic artery, with gross haemoperitoneum suggestive of a ruptured pseudoaneurysm. Emergency laparotomy was done under general anaesthesia, the bleeding pseudoaneurysm spotted and ligated ,haemostasis was achieved and the abdomen was closed. Recovery period was uneventful.

CONCLUSION: Hemoperitonium due to ruptured hepatic artery aneurysm in a postoperative case of hepaticojejunostomy is rare, and warrants urgent management stratergies as it can be fatal.