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Lampropoulos C, Markopoulos G, Tsochatzis S, Bellou A, Amanatidis T, Kehagias D, Papadopoulos G, Kehagias I. Symptomatic pseudoaneurysms following laparoscopic cholecystectomy: Focus on an unusual and dangerous complication. J Minim Access Surg 2021; 17:450-457. [PMID: 34558424 PMCID: PMC8486062 DOI: 10.4103/jmas.jmas_164_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/03/2020] [Accepted: 09/20/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) has been associated with an increase in the incidence of biliary and vascular injuries. Pseudoaneurysms (PAs) following LC are rare life-threatening events with limited available experience regarding diagnosis and treatment. MATERIALS AND METHODS An extensive review of literature during a 26-year period (1994-2020) using MEDLINE® database and Google Scholar® academic search engine revealed 134 patients with at least one symptomatic PA following LC. RESULTS Nearly. 81% of patients with PAs become symptomatic during the first 8 weeks following LC. The most common symptoms were gastrointestinal bleeding (74%) and abdominal pain (61%). In 28% of cases, there was a concomitant bile duct injury or leak from the cystic duct stump, whereas in about one-third of cases, PAs presented following an uneventful LC. The most common involved arteries were the right hepatic artery (70%), the cystic artery (19%) or both of them (3%). Trans-arterial embolisation was the favoured first-line treatment with a success rate of 83%. During a median follow-up of 9 months, the mortality rate was 7%. CONCLUSION Clinicians should be aware of the PA occurrence following LC. Prompt diagnosis and treatment are essential.
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Affiliation(s)
| | | | | | - Aggeliki Bellou
- Department of Pulmonary Medicine, General University Hospital of Patras, Patras, Greece
| | | | - Dimitrios Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | | | - Ioannis Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
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Abstract
Cholecystectomy is one of the most common general surgery procedures performed worldwide. Complications include bile duct injury, strictures, bleeding, infection/abscess, retained gallstones, hernias, and postcholecystectomy syndrome. Obtaining a critical view of safety and following the other tenets of the Safe Cholecystectomy Task Force will aid in the prevention of bile duct injury and other morbidity associated with cholecystectomy.
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Affiliation(s)
- Xiaoxi Chelsea Feng
- Department of Surgery, Cedars Sinai Medical Center, 8635 W Third Street, West Medical Office Tower, Suite 795, Los Angeles, CA 90048, USA
| | - Edward Phillips
- Department of Surgery, Cedars Sinai Medical Center, 8635 W Third Street, West Medical Office Tower, Suite 795, Los Angeles, CA 90048, USA
| | - Daniel Shouhed
- Department of Surgery, Cedars Sinai Medical Center, 459 North Croft Avenue, Los Angeles, CA 90048, USA.
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Abiko T, Ebihara Y, Takeuchi M, Sakamoto H, Homma H, Hirano S. Hemobilia-a rare complication after laparoscopic cholecystectomy. Surg Case Rep 2020; 6:91. [PMID: 32372325 PMCID: PMC7200960 DOI: 10.1186/s40792-020-00837-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/06/2020] [Indexed: 11/21/2022] Open
Abstract
Background Biliary bleeding is a condition reported by Sandblom as hemobilia. The most common cause of hemobilia is iatrogenicity. But it has also been reported as a rare complication after laparoscopic cholecystectomy (LC). Case presentation A man in his 60s underwent a LC. He was taking a direct Xa inhibitor for paroxysmal atrial fibrillation (pAf) and had a history of thrombectomy. There was variation in the bifurcation of the hepatic artery and cystic artery. The right hepatic artery branches from the common hepatic artery by itself, and the cystic artery is double. He complained of right upper quadrant pain, nausea, and vomiting on the third postoperative day (3POD). Non-contrast computed tomography (CT) showed that a high absorption area was found to fill the common bile duct. Contrast CT showed no pseudoaneurysm formation. Ultimately, he was diagnosed with postoperative hemobilia. Angiographic examination selective for the cystic artery branching from the middle hepatic artery revealed leakage of the contrast agent and a micro-pseudoaneurysm. Conclusions We encountered a case of hemobilia after LC. In this case, it was presumed that in addition to the chronic inflammatory changes of the gallbladder wall, extraordinary bifurcation of the hepatic artery and the cystic arteries and easy bleeding due to resumption of a direct Xa inhibitor synergistically caused a micro-pseudoaneurysm and postoperative hemobilia. It was difficult to identify the cause of hemobilia by contrast CT alone. Angiographic examination was useful for identifying and treating the causative artery and needs to perform aggressively.
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Affiliation(s)
- Takehiro Abiko
- Gastroenterological Surgery, Sapporo Kyoritsu Gorinbashi Hospital, 1-chome, Kawazoe 1-jo, Minami-ku, Sapporo, Hokkaido, 0050802, Japan
| | - Yuma Ebihara
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan.
| | - Motoya Takeuchi
- Gastroenterological Surgery, Sapporo Kyoritsu Gorinbashi Hospital, 1-chome, Kawazoe 1-jo, Minami-ku, Sapporo, Hokkaido, 0050802, Japan
| | - Hiroki Sakamoto
- Gastroenterology, Sapporo Kyoritsu Gorinbashi Hospital, 1-chome, Kawazoe 1-jo, Minami-ku, Sapporo, Hokkaido, 0050802, Japan
| | - Hisato Homma
- Gastroenterology, Sapporo Kyoritsu Gorinbashi Hospital, 1-chome, Kawazoe 1-jo, Minami-ku, Sapporo, Hokkaido, 0050802, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan
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Kassem TW. Right hepatic artery pseudoaneurysm as complication of laparoscopic cholecystectomy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Machado NO, Al-Zadjali A, Kakaria AK, Younus S, Rahim MA, Al-Sukaiti R. Hepatic or Cystic Artery Pseudoaneurysms Following a Laparoscopic Cholecystectomy: Literature review of aetiopathogenesis, presentation, diagnosis and management. Sultan Qaboos Univ Med J 2017; 17:e135-e146. [PMID: 28690884 DOI: 10.18295/squmj.2016.17.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/22/2016] [Accepted: 10/22/2016] [Indexed: 01/28/2023] Open
Abstract
Pseudoaneurysms (PSAs) of the hepatic and/or cystic artery are a rare complication following a laparoscopic cholecystectomy (LC). Generally, PSA cases present with haemobilia several weeks following the procedure. Transarterial embolisation (TAE) is considered the optimal management approach. We report a 70-year-old woman who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in 2016 with massive hemoperitoneum two weeks after undergoing a LC procedure in another hospital. She was successfully managed using coil TAE. An extensive literature review revealed 101 cases of hepatic or cystic artery PSAs following a LC procedure. Haemobilia was the main presentation (85.1%) and the mean time of postoperative presentation was 36 days. The hepatic artery was involved in most cases (88.1%), followed by the cystic artery (7.9%) and a combination of both (4.0%). Most cases were managed with TAE (72.3%), with a 94.5% success rate. The overall mortality rate was 2.0%.
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Affiliation(s)
- Norman O Machado
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Adil Al-Zadjali
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Anupam K Kakaria
- Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shahzad Younus
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mohamed A Rahim
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Rashid Al-Sukaiti
- Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
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Feng W, Yue D, ZaiMing L, ZhaoYu L, Wei L, Qiyong G. Hemobilia following laparoscopic cholecystectomy: computed tomography findings and clinical outcome of transcatheter arterial embolization. Acta Radiol 2017; 58:46-52. [PMID: 26987672 DOI: 10.1177/0284185116638570] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 02/13/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Hemobilia following laparoscopic cholecystectomy (LC) can occur in the early or late postoperative course and poses a diagnostic and therapeutic challenge. PURPOSE To assess computed tomography (CT) findings and clinical outcomes after transcatheter arterial embolization (TAE) in patients presenting with hemobilia following LC. MATERIAL AND METHODS Fourteen patients treated for hemobilia following LC were included in the study. Three patients were diagnosed by endoscopy and 11 by abdominal contrast-enhanced CT. Coils or microcoils were superselectively deployed to occlude the bleeding vessel during TAE. Abdominal CT findings of hemobilia, and the success rate and complication of TAE were observed. RESULTS Abdominal CT provided the following signs of hemobilia: hematoma within the abdominal cavity and gallbladder fossa, blood clots containing high attenuation within the bile duct, biliary dilatation, pseudoaneurysm of the right hepatic artery, contrast extravasation, enhancement of the bile duct wall, and hypoperfusion of the right lobe. The success rate of TAE was 100% and rebleeding did not occur in any patient. Post-embolization syndrome and hepatic ischemia occurred in nine patients, which was associated with age and the time interval between the LC and TAE. CONCLUSION Abdominal CT provided direct signs that can aid in the diagnosis of hemobilia after LC. TAE allowed for successful treatment of hemobilia with minor complications.
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Affiliation(s)
- Wen Feng
- Department of Radiology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Dong Yue
- Department of Radiology, China Medical University Cancer Hospital, LiaoNing Cancer Hospital, Shenyang, Liaoning, PR China
| | - Lu ZaiMing
- Department of Radiology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Liu ZhaoYu
- Department of Radiology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Li Wei
- Department of Radiology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Guo Qiyong
- Department of Radiology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, PR China
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Hemobilia After Laparoscopic Cholecystectomy: Imaging Features and Management of an Unusual Complication. Surg Laparosc Endosc Percutan Tech 2016; 26:e18-24. [PMID: 26766321 DOI: 10.1097/sle.0000000000000241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To assess the imaging features and the management of hemobilia after laparoscopic cholecystectomy (LC). MATERIALS AND METHODS A total of 12 patients who were treated for hemobilia after LC were included in the study. Selective arteriography was performed to find the bleeding artery. Coils or microcoils were deployed superselectively to occlude the bleeding branch. The clinical course, imaging findings, the embolic effect, complications, and follow-up were evaluated. RESULTS Risk factors for hemobilia included a variant ductal anatomy, a variant cystic artery, and intraoperative adhesion. Abdominal computed tomography (CT) could provide the diagnostic signs as follows: a hematocele in the abdominal cavity, the gallbladder fossa, and the bile duct, biliary dilation, pseudoaneurysm of the right hepatic artery, and contrast extravasations on contrast-enhanced CT. No rebleeding occurred after the transcatheter arterial embolization in all patients without immediate procedural complications. CONCLUSIONS Gallbladder triangle anatomic variation and intraoperative adhesion were the risk factors for hemobilia after LC. Abdominal CT is a useful examination for the diagnosis. Transcatheter arterial embolization is the therapeutic option of choice.
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Raashed S, Chandrasegaram MD, Alsaleh K, Schlaphoff G, Merrett ND. Vascular coil erosion into hepaticojejunostomy following hepatic arterial embolisation. BMC Surg 2015; 15:51. [PMID: 25925841 PMCID: PMC4423092 DOI: 10.1186/s12893-015-0039-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/24/2015] [Indexed: 01/22/2023] Open
Abstract
Background Right hepatic arterial injury (RHAI) is the most common vascular injury sustained during laparoscopic cholecystectomy, occurring in up to 7% of cholecystectomies. RHAI is also the most common vascular injury associated with a bile duct injury (BDI) and is reported to occur in up to 41 – 61% of cases when routine angiography is employed following a BDI. We present an unusual case of erosion of vascular coils from a previously embolised right hepatic artery into bilio-enteric anastomoses causing biliary obstruction. This is on a background of biliary reconstruction following a major BDI. Case presentation A 37-year old man underwent a bile duct reconstruction following a major BDI (Strasberg-Bismuth E4 injury) sustained at laparoscopic cholecystectomy. He had two separate bilio-enteric anastomoses of the right and left hepatic ducts and had a modified Terblanche Roux-en-Y access limb formed. Approximately three weeks later he was admitted for significant gastrointestinal bleeding and was hypotensive and anaemic. Selective computed tomography angiography revealed a 2 x 2 centimetre right hepatic artery pseudoaneurysm, which was urgently embolised with radiological coils. Two months later he developed intermittent fevers, rigors, jaundice, and right upper quadrant pain with evidence of intrahepatic biliary dilatation on magnetic resonance cholangiopancreatography. The degree of intrahepatic biliary dilatation progressively increased on subsequent imaging over several months, suggesting stricturing of the bilio-enteric anastomoses. Several attempts to traverse these strictures with a percutaneous transhepatic approach had failed. Then, approximately ten months after the initial BDI repair, choledochoscopy through the Terblanche access limb revealed multiple radiological coils within the bilio-enteric anastomoses, which had eroded from the previously embolised right hepatic artery. A laparotomy was performed to remove the coils, take down the existing obstructed bilio-enteric anastomoses and revise this. Following this the patient recovered uneventfully. Conclusion Obstructive jaundice and cholangitis secondary to erosion of angiographically placed embolisation coils is a rarely described complication. In view of the relative frequency of arterial injury and complications following major bile duct injury, we suggest that these patients be formally assessed for associated arterial injury following a major BDI.
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Affiliation(s)
- Soondoos Raashed
- Upper Gastrointestinal Unit, Bankstown Hospital, Sydney, Australia
| | - Manju D Chandrasegaram
- Upper Gastrointestinal Unit, Bankstown Hospital, Sydney, Australia.,Division of Surgery, School of Medicine, University of Western Sydney, Sydney, Australia
| | - Khaled Alsaleh
- Upper Gastrointestinal Unit, Bankstown Hospital, Sydney, Australia
| | - Glen Schlaphoff
- Interventional and Diagnostic Radiology, Liverpool Hospital, Sydney, Australia
| | - Neil D Merrett
- Upper Gastrointestinal Unit, Bankstown Hospital, Sydney, Australia. .,Division of Surgery, School of Medicine, University of Western Sydney, Sydney, Australia.
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9
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Hsiao CY, Kuo TC, Lai HS, Yang CY, Tien YW. Obstructive jaundice as a complication of a right hepatic artery pseudoaneurysm after laparoscopic cholecystectomy. J Minim Access Surg 2015; 11:163-4. [PMID: 25883462 PMCID: PMC4392495 DOI: 10.4103/0972-9941.144097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 08/25/2014] [Indexed: 11/16/2022] Open
Abstract
A hepatic artery pseudoaneurysm is a rare, but a potentially life-threatening complication after laparoscopic cholecystectomy (LC). Obstructive jaundice owing to a hepatic artery pseudoaneurysm after LC has never been reported. We report a patient with a hepatic artery pseudoaneurysm after LC who presented with tarry stools, bloody drainage and obstructive jaundice.
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Affiliation(s)
- Chih-Yang Hsiao
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ting-Chun Kuo
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hong-Shiee Lai
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ching-Yao Yang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Wen Tien
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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10
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Acosta RD, Wong RKH. Differential diagnosis of upper gastrointestinal bleeding proximal to the ligament of Trietz. Gastrointest Endosc Clin N Am 2011; 21:555-66. [PMID: 21944410 DOI: 10.1016/j.giec.2011.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Upper gastrointestinal bleeding (UGIB) is an important medical problem for patients and the medical system. The causes of UGIB are varied and their accurate identification guides appropriate management. The major cause of UGIB is peptic ulcer disease, for which Helicobacter pylori and nonsteroidal antiinflammatory drug use are major risk factors. Lesser causes include Dieulafoy lesion, gastric antral vascular ectasia, hemobilia, aortoenteric fistulas, and upper gastrointestinal tumors. Awareness of causes and management of UGIB should allow physicians to treat their patients more effectively.
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Affiliation(s)
- Ruben D Acosta
- Division of Gastroenterology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
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Strasberg SM, Helton WS. An analytical review of vasculobiliary injury in laparoscopic and open cholecystectomy. HPB (Oxford) 2011; 13:1-14. [PMID: 21159098 PMCID: PMC3019536 DOI: 10.1111/j.1477-2574.2010.00225.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 07/22/2010] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Biliary injuries are frequently accompanied by vascular injuries, which may worsen the bile duct injury and cause liver ischemia. We performed an analytical review with the aim of defining vasculobiliary injury and setting out the important issues in this area. METHODS A literature search of relevant terms was performed using OvidSP. Bibliographies of papers were also searched to obtain older literature. RESULTS Vasculobiliary injury was defined as: an injury to both a bile duct and a hepatic artery and/or portal vein; the bile duct injury may be caused by operative trauma, be ischaemic in origin or both, and may or may not be accompanied by various degrees of hepatic ischaemia. Right hepatic artery (RHA) vasculobiliary injury (VBI) is the most common variant. Injury to the RHA likely extends the biliary injury to a higher level than the gross observed mechanical injury. VBI results in slow hepatic infarction in about 10% of patients. Repair of the artery is rarely possible and the overall benefit unclear. Injuries involving the portal vein or common or proper hepatic arteries are much less common, but have more serious effects including rapid infarction of the liver. CONCLUSIONS Routine arteriography is recommended in patients with a biliary injury if early repair is contemplated. Consideration should be given to delaying repair of a biliary injury in patients with occlusion of the RHA. Patients with injuries to the portal vein or proper or common hepatic should be emergently referred to tertiary care centers.
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Affiliation(s)
- Steven M Strasberg
- Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Washington University in Saint Louis, St Louis, MO 63110, USA.
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Strasberg SM, Helton WS. An analytical review of vasculobiliary injury in laparoscopic and open cholecystectomy. HPB (Oxford) 2010. [PMID: 21159098 DOI: 10.1111/j.1477-2574.2010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
OBJECTIVES Biliary injuries are frequently accompanied by vascular injuries, which may worsen the bile duct injury and cause liver ischemia. We performed an analytical review with the aim of defining vasculobiliary injury and setting out the important issues in this area. METHODS A literature search of relevant terms was performed using OvidSP. Bibliographies of papers were also searched to obtain older literature. RESULTS Vasculobiliary injury was defined as: an injury to both a bile duct and a hepatic artery and/or portal vein; the bile duct injury may be caused by operative trauma, be ischaemic in origin or both, and may or may not be accompanied by various degrees of hepatic ischaemia. Right hepatic artery (RHA) vasculobiliary injury (VBI) is the most common variant. Injury to the RHA likely extends the biliary injury to a higher level than the gross observed mechanical injury. VBI results in slow hepatic infarction in about 10% of patients. Repair of the artery is rarely possible and the overall benefit unclear. Injuries involving the portal vein or common or proper hepatic arteries are much less common, but have more serious effects including rapid infarction of the liver. CONCLUSIONS Routine arteriography is recommended in patients with a biliary injury if early repair is contemplated. Consideration should be given to delaying repair of a biliary injury in patients with occlusion of the RHA. Patients with injuries to the portal vein or proper or common hepatic should be emergently referred to tertiary care centers.
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Affiliation(s)
- Steven M Strasberg
- Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Washington University in Saint Louis, St Louis, MO 63110, USA.
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Postlaparoscopic iatrogenic pseudoaneurysms of the arteries of the peritoneal and retroperitoneal space: case report and review of the literature. Surg Laparosc Endosc Percutan Tech 2010; 19:90-7. [PMID: 19390271 DOI: 10.1097/sle.0b013e31819ca96b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Laparoscopic surgery procedures are associated with a low percentage of cases of iatrogenic traumatic laceration of the arteries of the peritoneal and retroperitoneal space. These lesions rarely lead to pseudoaneurysm formation. In 1 case, we performed a meta-analytic review of the literature on postlaparoscopic iatrogenic pseudoaneurysms focusing on specific parameters: (1) artery involved, (2) type of laparoscopic operation, (3) time interval between the laparoscopic operation and the final diagnosis of the pseudoaneurysm, (4) clinical presentation, (5) diagnostic tools used, (6) mode of treatment applied, and (7) clinical outcome. MATERIALS AND METHODS We searched Medline for pseudoaneurysms developing as complications of laparoscopic procedures. The search terms used were "iatrogenic pseudoaneurysm," "complications after laparoscopic procedures," "traumatic arterial laceration," "pseudoaneurysm formation," and "postoperative hematoma" in various combinations. RESULTS AND CONCLUSIONS A total of 66 cases were retrieved. Postlaparoscopic iatrogenic pseudoaneurysms are late manifestations of arterial complications developing during routine laparoscopy. There are 66 reported cases of this type of complication in the literature. The majority occurs in the arteries of the operation field of the respective laparoscopic procedure. Distal vessels are involved less frequently. They usually present after a mean period of approximately 6 weeks. The hepatic and renal arteries are usually affected. The clinical picture includes upper and lower gastrointestinal bleeding, diffuse or localized abdominal pain, hematuria, and drain bleeding.
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14
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Yao CA, Arnell TD. Hepatic artery pseudoaneurysm following laparoscopic cholecystectomy. Am J Surg 2010; 199:e10-1. [PMID: 20103061 DOI: 10.1016/j.amjsurg.2009.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 03/19/2009] [Accepted: 03/19/2009] [Indexed: 02/08/2023]
Abstract
Hepatic artery pseudoaneurysm is a rare and potentially fatal complication of laparoscopic cholecystectomy that often presents with abdominal pain, anemia, hemobilia, and liver function elevations. The authors report a case of hepatic artery pseudoaneurysm diagnosed by abdominal computed topography in a 54-year-old man who had undergone laparoscopic cholecystectomy the previous month. Definitive treatment was angiography with embolization.
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Affiliation(s)
- Caroline A Yao
- Columbia University Medical Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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Carrafiello G, Laganà D, Dizonno M, Cotta E, Ianniello A, Fugazzola C. Emergency percutaneous treatment in iatrogenic hepatic arterial injuries. Emerg Radiol 2008; 15:249-54. [PMID: 18404280 DOI: 10.1007/s10140-008-0715-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Accepted: 02/21/2008] [Indexed: 02/06/2023]
Abstract
The purpose of this report is to present our experience in the emergency percutaneous treatment of patients with iatrogenic hepatic arterial injury (IHAI). Seven patients (six men, one woman; age range 19-78 years; mean age 63 years) with IHAI secondary to surgical or percutaneous procedures were treated with endovascular percutaneous procedures. We performed six transhepatic arterial embolization (TAE) and one placement of an endograft stent. Follow-up was carried out by ultrasound (US) or computed tomography (CT) after 1, 3, 6, and 12 months, yearly thereafter and by laboratory tests in the first 6 months to completely exclude occult and asymptomatic bleeding. All procedures had 100% technical success. No case of further bleeding was seen at follow-up. In one patient, we detected one abscess after 3 weeks, which was treated by antibiotic therapy. In conclusion, endovascular treatment currently represents a valid option in emergency settings, as it the enables diagnosis and treatment of IHAI in a single session.
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Moukaddam H, Al-Kutoubi A. Pseudoaneurysms of Hepatic Artery Branches: Treatment with Self-expanding Stent-grafts in Two Cases. J Vasc Interv Radiol 2007; 18:897-901. [PMID: 17609450 DOI: 10.1016/j.jvir.2007.04.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Pseudoaneurysms of the hepatic artery or its branches are rare complications with several potential causes. Herein, the authors report two cases of pseudoaneurysms of hepatic artery branches, one secondary to laparoscopic surgery and the other probably due to malignancy. The pseudoaneurysms were treated with the placement of self-expanding stent-grafts. Complete and prompt occlusion of the pseudoaneurysm was achieved in both patients, with resolution of symptoms and preservation of the blood flow in the parent arterial branch at long-term follow-up.
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Affiliation(s)
- Hicham Moukaddam
- Department of Diagnostic Radiology, the American University of Beirut Medical Center, Beirut, Lebanon
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Bilbao Jaureguízar JI, Vivas Pérez I, Cano Rafart D, Martínez de la Cuesta A. Imaging and Intervention in Gastrointestinal Hemorrhage and Ischemia. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tajima Y, Kuroki T, Tsutsumi R, Sakamoto I, Uetani M, Kanematsu T. Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery. World J Gastroenterol 2007; 13:408-13. [PMID: 17230610 PMCID: PMC4065896 DOI: 10.3748/wjg.v13.i3.408] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effects of extrahepatic collaterals to the liver on liver damage and patient outcome after embolotherapy for the ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery.
METHODS: We reviewed 9 patients who underwent transcatheter arterial embolization (TAE) for the ruptured hepatic artery pseudoaneurysm following major hepatobiliary pancreatic surgery between June 1992 and April 2006. We paid special attention to the extrahepatic arterial collaterals to the liver which may affect post-TAE liver damage and patient outcome.
RESULTS: The underlying diseases were all malignancies, and the surgical procedures included hepatopancreatoduodenectomy in 2 patients, hepatic resection with removal of the bile duct in 5, and pancreaticoduodenectomy in 2. A total of 11 pseudoaneurysm developed: 4 in the common hepatic artery, 4 in the proper hepatic artery, and 3 in the right hepatic artery. Successful hemostasis was accomplished with the initial TAE in all patients, except for 1. Extrahepatic arterial pathways to the liver, including the right inferior phrenic artery, the jejunal branches, and the aberrant left hepatic artery, were identified in 8 of the 9 patients after the completion of TAE. The development of collaterals depended on the extent of liver mobilization during the hepatic resection, the postoperative period, the presence or absence of an aberrant left hepatic artery, and the concomitant arterial stenosis adjacent to the pseudoaneurysm. The liver tolerated TAE without significant consequences when at least one of the collaterals from the inferior phrenic artery or the aberrant left hepatic artery was present. One patient, however, with no extrahepatic collaterals died of liver failure due to total liver necrosis 9 d after TAE.
CONCLUSION: When TAE is performed on ruptured hepatic artery pseudoaneurysm, reduced collateral pathways to the liver created by the primary surgical procedure and a short postoperative interval may lead to an unfavorable outcome.
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Affiliation(s)
- Yoshitsugu Tajima
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
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Ren FY, Piao XX, Jin AL. Delayed hemorrhage from hepatic artery after ultrasound-guided percutaneous liver biopsy: A case report. World J Gastroenterol 2006; 12:4273-5. [PMID: 16830394 PMCID: PMC4087393 DOI: 10.3748/wjg.v12.i26.4273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Percutaneous liver biopsy is considered one of the most important diagnostic tools to evaluate diffuse liver diseases. Pseudoaneurysm of hepatic artery is an unusual complication after ultrasound-guided percutaneous liver biopsy. Delayed hemorrhage occurs much less frequently. We report a case of pseudoaneurysm of the hepatic artery of a 46-year-old man who was admitted for abdominal pain after 4 d of liver biopsy. The bleeding was controlled initially by angiographic embolization. However, recurrent bleeding could not be controlled by repeat angiography, and the patient died 4 d after admission from multiorgan failure. The admittedly rare possibility of delayed hemorrhage should be considered whenever a liver biopsy is performed.
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Affiliation(s)
- Fen-Yu Ren
- Department of Gastroenterology and Hepatology, Yanbian University Hospital, Yanji 133000, Jilin Province, China.
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20
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Abstract
BACKGROUND The formation of a pseudoaneurysm of the cystic artery is a rare occurrence after laparoscopic cholecystectomy. CASE OUTLINE Seven weeks after laparoscopic cholecystectomy, a 31-year-old woman presented with a picture of obstructive jaundice. The diagnosis of cystic artery aneurysm was verified by arteriography, CT and MRCP. At laparotomy the pseudoaneurysm was found to be compressing the common bile duct. It was successfully managed by ligation of the right hepatic artery. DISCUSSION Although this complication is rare, the surgeon must have a high index of suspicion to make the diagnosis.
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Affiliation(s)
- O. L. De Molla Neto
- Department of Liver Transplant and Surgery, Hospital Santa PaulaSão PauloBrazil
| | - M. A. F. Ribeiro
- Department of Liver Transplant and Surgery, Hospital Santa PaulaSão PauloBrazil
| | - W. A. Saad
- Department of Liver Transplant and Surgery, Hospital Santa PaulaSão PauloBrazil
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21
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Journé S, De Simone P, Laureys M, Le Moine O, Gelin M, Closset J. Right hepatic artery pseudoaneurysm and cystic duct leak after laparoscopic cholecystectomy. Surg Endosc 2004; 18:554-6. [PMID: 15115027 DOI: 10.1007/s00464-003-4262-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Laparoscopic cholecystectomy (LC) seems to be associated with an increased risk of biliary or vascular injuries. Hepatic artery pseudoaneurysms (HAP) are rare complications of LC. HAP can occur in the early or late postoperative period. Patients with HAP present with abdominal pain, hemobilia, and liver function test (LFT) alterations. We report the case of a patient who was affected with a cystic duct stump leak associated with a right HAP and was treated by endoscopic biliary drainage and angiographic coil embolization.
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Affiliation(s)
- S Journé
- Medicosurgical Department of Gastroenterology, Erasmus Hospital, Free University of Brussels, 808 route de Lennik, 1070 Brussels, Belgium
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Tessier DJ, Fowl RJ, Stone WM, McKusick MA, Abbas MA, Sarr MG, Nagorney DM, Cherry KJ, Gloviczki P. Iatrogenic hepatic artery pseudoaneurysms: an uncommon complication after hepatic, biliary, and pancreatic procedures. Ann Vasc Surg 2003; 17:663-9. [PMID: 14564553 DOI: 10.1007/s10016-003-0075-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatic artery pseudoaneurysms are uncommon but potentially lethal complications of hepatic, biliary, and pancreatic interventions. To enhance our knowledge about these pseudoaneurysms, we reviewed our institution's experience with the management of these lesions. We reviewed the literature on 136 cases of hepatic artery pseudoaneurysms as well as our experience with 17 patients (excluding patients who were post-transplantation or had suffered abdominal trauma). The causes, pathogenesis, and clinical features were analyzed. Ten women and seven men developed hepatic artery pseudoaneurysms after undergoing hepatic (65%), biliary (30%), or pancreatic procedures (5%). The mean time between initial intervention and diagnosis was 5.7 months (range 7 days-38 months). Rupture occurred in 13 patients (76%). Mean pseudoaneurysm size was 1.9 cm (range 0.7-4 cm). Embolization was successful in 12 of 14 patients (86%). Four patients (24%), including the two who failed embolization, required operative intervention. Postoperative mortality was 25% while postembolization mortality was 14%. One patient was observed, and the aneurysm thrombosed at 72 months follow-up. Mean follow-up was 48 months (range 1-184 months) for 13 of the 14 survivors (93%) (1 patient was lost to follow-up) without any clinical sequela. Hepatic artery pseudoaneurysms are rare. Rupture is common and occurred in 76% of patients. For both ruptured and nonruptured cases angiography with embolization of the pseudoaneurysm is safe and effective. Operative intervention should be reserved for patients for whom embolization fails or for whom it is not feasible.
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Affiliation(s)
- Deron J Tessier
- Department of Surgery, Division of Vascular Surgery, Mayo Clinic Scottsdale, Scottsdale, AZ 85259, USA
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23
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Ferrari AP, Ferreira JPA, de Paulo GA, Líbera ED. Hemobilia caused by a mycotic aneurysm of the hepatic artery treated by enbucrilate injection during ERCP. Gastrointest Endosc 2003; 57:260-3. [PMID: 12556800 DOI: 10.1067/mge.2003.65] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
MESH Headings
- Adult
- Aneurysm, False/complications
- Aneurysm, False/diagnosis
- Aneurysm, False/therapy
- Aneurysm, Infected/complications
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Aneurysm, Ruptured/complications
- Aneurysm, Ruptured/diagnosis
- Aneurysm, Ruptured/therapy
- Cholangiopancreatography, Endoscopic Retrograde/adverse effects
- Cholangiopancreatography, Endoscopic Retrograde/methods
- Disease Progression
- Down Syndrome
- Embolization, Therapeutic/methods
- Enbucrilate/therapeutic use
- Endoscopy, Digestive System
- Fatal Outcome
- Hemobilia/diagnosis
- Hemobilia/etiology
- Hemobilia/therapy
- Hepatic Artery
- Humans
- Male
- Risk Assessment
- Tomography, X-Ray Computed
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Affiliation(s)
- Angelo Paulo Ferrari
- Digestive Endoscopy Unit-Gastroenterology Division, Department of Medicine, Hospital São Paulo, Universidade Federal de São Paulo, Brazil
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24
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Ozkan OS, Walser EM, Akinci D, Nealon W, Goodacre B. Guglielmi detachable coil erosion into the common bile duct after embolization of iatrogenic hepatic artery pseudoaneurysm. J Vasc Interv Radiol 2002; 13:935-8. [PMID: 12354829 DOI: 10.1016/s1051-0443(07)61778-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intermittent hemobilia with a hepatic artery pseudoaneurysm can be seen after open or laparoscopic cholecystectomy. Transcatheter treatment of this complication is widely accepted. Although some authors suggest packing the pseudoaneurysm with coils as the treatment of choice, occluding the parent artery is the standard treatment. The authors present an unusual complication of Guglielmi detachable coil erosion into the common bile duct in a patient who presented with pancreatitis 2 years after undergoing packing of the hepatic artery pseudoaneurysm with coils. The probable causes of this rare outcome and alternative treatment options are discussed.
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Affiliation(s)
- Orhan S Ozkan
- Departments of Radiology, University of Texas Medical Branch, Galveston, Texas 77555-0709, USA.
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25
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Mahi M, Chellaoui M, Chat L, Achabâan F, Alami D, Najid A, el Hassani M, Benamour-Ammar H. [Post-traumatic hepatic artery pseudoaneurysm. A case report]. Arch Pediatr 2001; 8:720-3. [PMID: 11484454 DOI: 10.1016/s0929-693x(00)00304-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CASE REPORT We report a case of traumatic hepatic artery pseudoaneurysm in a 9-year-old child. The diagnosis was made by duplex sonography and helical CT angiography. Arteriography confirmed and managed the lesion with transcatheter embolization. CONCLUSION The traumatic hepatic artery pseudoaneurysm is an uncommon complication of liver trauma in children whose diagnosis is made by duplex sonography and CT angiography. Endovascular embolotherapy is the treatment of choice.
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Affiliation(s)
- M Mahi
- Service de radiologie pédiatrique, CHU Ibn Sina, Rabat, Maroc.
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Abstract
BACKGROUND This review aims to establish whether increased use of invasive procedures and the trend toward conservative management of major trauma has resulted in an increased incidence of haemobilia. METHOD A Medline (http://igm.nlm.nih.gov/)-based search of the English language literature from January 1996 to December 1999 inclusive was performed using the keywords haemobilia, hemobilia, haematobilia and hematobilia. The presentation, aetiology, investigation, management and outcome of 222 cases were reviewed. RESULTS Two-thirds of cases were iatrogenic while accidental trauma accounted for 5 per cent. Haemobilia may be major, constituting life-threatening haemorrhage, or minor; it may present many weeks after the initial injury. Diagnosis is most commonly confirmed by angiography. Management is aimed at stopping bleeding and relieving biliary obstruction; 43 per cent of cases were managed conservatively and 36 per cent were managed by transarterial embolization (TAE). Surgery was indicated when laparotomy was performed for other reasons and for failed TAE. The mortality rate was 5 per cent. CONCLUSIONS Although the incidence of iatrogenic haemobilia has risen considerably, the bleeding is often minor and can be managed conservatively. When more urgent intervention is required, TAE is usually the treatment of choice. There is no evidence that the conservative management of accidental liver trauma increases the risk of haemobilia.
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Affiliation(s)
- M H Green
- Department of Surgery, Southampton General Hospital, Southampton, UK.
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27
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Doctor N, Dooley JS, Dick R, Watkinson A, Rolles K, Davidson BR. Multidisciplinary approach to biliary complications of laparoscopic cholecystectomy. Br J Surg 1998; 85:627-32. [PMID: 9635808 DOI: 10.1046/j.1365-2168.1998.00662.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bile leaks and bile duct strictures are major complications of cholecystectomy which increased in incidence after the introduction of laparoscopic surgery. The management and outcome of these complications following the introduction of laparoscopic cholecystectomy was reviewed. METHODS Eighteen patients of median age 45 (range 22-70) years were treated between January 1992 and December 1995. Six patients had a common hepatic duct (CHD) stricture, four following a failed previous repair. Nine patients had bile leaks from bile duct transection (four), cystic stump (four) or segment V duct (one). Two patients had partial bile duct damage with primary sutured repair at time of cholecystectomy. One patient had recurrent haemobilia from a hepatic artery pseudoaneurysm. RESULTS Cystic stump or segment V leaks were treated successfully by endoscopic stenting (median follow-up 42 months). Roux loop biliary reconstruction was carried out in nine patients: two CHD strictures, three of the four failed primary CHD repairs and four bile duct transections. All had normal liver function test results at median follow-up of 30 months. The two patients with partial duct injuries repaired at initial surgery required no further intervention. The right hepatic artery aneurysm was successfully embolized. There have been no deaths or major complications of endoscopic, radiological or surgical intervention. CONCLUSION Endoscopic stenting successfully treats cystic stump and segment V duct leaks. Duct strictures, including failed initial repairs and transections, have a good outcome with Roux-en-Y loop reconstruction.
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Affiliation(s)
- N Doctor
- Department of Surgery, Royal Free Hospital and Medical School, London, UK
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28
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Brountzos EN, Alexopoulou E, Malagari K, Thanos L, Papaioannou G, Kelekis DA. Hepatic artery pseudoaneurysm complicating laparoscopic cholecystectomy: Management with transcatheter embolisation. MINIM INVASIV THER 1998. [DOI: 10.3109/13645709809153120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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29
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Ribeiro A, Williams H, May G, Fulmer JT, Spivey JR. Hemobilia due to hepatic artery pseudoaneurysm thirteen months after laparoscopic cholecystectomy. J Clin Gastroenterol 1998; 26:50-3. [PMID: 9492864 DOI: 10.1097/00004836-199801000-00013] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Although vascular complications following laparoscopic cholecystectomy are rare, hemobilia may occur within the first 4 weeks after surgery. We report a 57-year-old woman with hemobilia secondary to a pseudoaneurysm of the right hepatic artery presenting 13 months after laparoscopic cholecystectomy. To our knowledge, such late presentation has never before been reported.
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Affiliation(s)
- A Ribeiro
- Department of Gastroenterology, Mayo Clinic Jacksonville, FL 32224, USA
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