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Nouri A, Bensaad A, Ghaddou Y, Khalid S, Abdelaziz F. Surgical Treatment of Pseudoaneurysm of the Right Hepatic Artery Following Cholecystectomy: A Case Report. Cureus 2024; 16:e61858. [PMID: 38975487 PMCID: PMC11227610 DOI: 10.7759/cureus.61858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
Pseudoaneurysms of the right hepatic artery following cholecystectomy are caused by either vascular damage or erosion after a biliary leak. Symptoms often include haemobilia, melena, vomiting, jaundice, and hemodynamic failure due to aneurysm rupture. The ideal treatment is arterial embolization or, in rare cases, stenting. We present a case of pseudoaneurysm of the right hepatic artery post-laparoscopic cholecystectomy. The patient presented with abdominal pain, vomiting, and hemodynamic failure on postoperative day 45. Magnetic resonance imaging (MRI) showed a large hematoma and a pseudoaneurysm of the right hepatic artery. A laparotomy was performed, and a large hematoma was found and evacuated. After the pringle maneuver, the pseudoaneurysm was resected. The right hepatic artery was ligated with clips, and a sub-hepatic drain was placed. The non-availability of emergency embolization forced surgical closure of the right hepatic artery, which is still the first-line treatment for such cases. Injury of the right hepatic artery is a rare complication, often overlooked by surgeons, and requires early diagnosis. Surgical treatment is reserved for cases of embolization failure or hemodynamic instability.
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Affiliation(s)
- Abdellah Nouri
- Surgery, Mohammed VI University of Health Sciences, Cheikh Khalifa International University Hospital, Casablanca, MAR
- Surgical Gastroenterology, Mohammed VI University of Health Sciences, Cheikh Khalifa International University Hospital, Casablanca, MAR
| | - Ahmed Bensaad
- General Surgery, Mohammed VI University of Health Sciences, Cheikh Khalifa International University Hospital, Casablanca, MAR
| | - Youssef Ghaddou
- General Surgery, Mohammed VI University of Health Sciences, Cheikh Khalifa International University Hospital, Casablanca, MAR
| | - Sair Khalid
- Surgery, Mohammed VI University of Health Sciences, Cheikh Khalifa International University Hospital, Casablanca, MAR
| | - Fadil Abdelaziz
- Surgery, Mohammed VI University of Health Sciences, Cheikh Khalifa International University Hospital, Casablanca, MAR
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Ahmed S, Filep R, Mushtaq A, Budisca O. Right Hepatic Artery Pseudoaneurysm Post-laparoscopic Cholecystectomy: A Case Report of Endovascular Stent-Graft Management. Cureus 2024; 16:e57127. [PMID: 38681270 PMCID: PMC11055570 DOI: 10.7759/cureus.57127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Gallstone-related diseases like cholelithiasis contribute significantly to global morbidity and mortality. Laparoscopic cholecystectomy (LC) is the gold standard for gallbladder removal but is associated with rare but severe complications, including hepatic artery pseudoaneurysms (PAs). A 72-year-old female presented with acute abdominal pain and upper gastrointestinal bleeding following a recent LC. Laboratory studies confirmed anemia with a hemoglobin level of 10 g/dL. Liver function tests were deranged, showing elevated alanine aminotransferase (ALT) at 209 U/L, aspartate aminotransferase (AST) at 472 U/L, total bilirubin levels at 3.29 mg/dL, and direct bilirubin levels at 2.7 mg/dL. A contrast-enhanced computed tomography scan revealed a PA adjacent to the right hepatic artery. Given the strong suspicion of a hepatic PA as the source of her symptoms, an endovascular stent was placed by an interventional radiologist. Post-procedure, the patient showed a favorable clinical course with cessation of symptoms and was discharged after eight days. This case emphasizes the importance of early identification of hepatic artery PAs following LC, a potentially life-threatening complication. It also suggests that endovascular stent placement can be an effective alternative to traditional transarterial embolization for managing these PAs. Additional research is needed to evaluate the long-term effectiveness and safety of these two methods in comparison.
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Affiliation(s)
- Sohaib Ahmed
- Surgery - I, County Emergency Clinical Hospital of Târgu Mureș, Targu Mures, ROU
| | - Rares Filep
- Interventional Radiology, County Emergency Clinical Hospital of Târgu Mureș, Targu Mures, ROU
| | - Ahsan Mushtaq
- Surgery - I, County Emergency Clinical Hospital of Târgu Mureș, Targu Mures, ROU
| | - Ovidiu Budisca
- Surgery - I, County Emergency Clinical Hospital of Târgu Mureș, Targu Mures, ROU
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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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Shishido Y, Fujimoto K, Yano Y, Mitsuoka E, Komatsubara T, Shio S, Ishii M, Higashiyama H. Emergency surgery for hemobilia due to hepatic artery pseudoaneurysm rupture complicated by Mirizzi syndrome type II: a case report. BMC Surg 2021; 21:318. [PMID: 34353316 PMCID: PMC8340468 DOI: 10.1186/s12893-021-01314-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/30/2021] [Indexed: 01/06/2023] Open
Abstract
Background Hemobilia refers to bleeding into the biliary tract. Hepatic artery pseudoaneurysm (HAP) rupture is an uncommon cause of hemobilia, and cases of HAP associated with Mirizzi syndrome are extremely rare. Although transarterial embolization is recommended as the first-line treatment for hemobilia, surgery is sometimes required. Case presentation A 76-year-old woman was referred to our hospital with epigastric pain. She was febrile and had conjunctival icterus and epigastric tenderness. Laboratory tests revealed abnormal white blood cell count and liver function. An abdominal computed tomography (CT) revealed multiple calculi in the gallbladder, an incarcerated calculus in the cystic duct, and a slightly dilated common hepatic duct. Based on examination findings, she was diagnosed with Mirizzi syndrome type I, complicated by cholangitis. Intravenous antibiotics were administered, and we performed endoscopic retrograde cholangiopancreatography (ERCP) to place a drainage tube. The fever persisted; therefore, contrast-enhanced CT (CECT) was performed. This revealed portal vein thrombosis and hepatic abscesses; therefore, heparin infusion was administered. The following day, she complained of melena, and laboratory tests showed that she was anemic. ERCP was performed to change the drainage tube in the bile duct; however, bleeding from the papilla of Vater was observed. CECT demonstrated a right HAP with high-density fluid in the gallbladder and gallbladder perforation. Finally, she was diagnosed with hemobilia caused by HAP rupture, and emergency surgery was performed to secure hemostasis and control the infection. During laparotomy, we found that a right HAP had ruptured into the gallbladder. The gallbladder made a cholecystobiliary fistula, which indicated Mirizzi syndrome type II. Although we tried to repair the right hepatic artery, we later ligated it due to arterial wall vulnerability. Then, we performed subtotal cholecystectomy and inserted a T-tube into the common bile duct. There were no postoperative complications except for minor leakage from the T-tube insertion site. The patient was discharged after a total hospital stay of 7 weeks. Conclusions We experienced an extremely rare case of emergency definitive surgery for hemobilia due to HAP rupture complicated by Mirizzi syndrome type II. Surgery might be indicated when controlling underlying infections was required.
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Affiliation(s)
- Yutaka Shishido
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, Hyogo, 6510072, Japan.
| | - Koji Fujimoto
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, Hyogo, 6510072, Japan
| | - Yasumichi Yano
- Department of Gastroenterology, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, Hyogo, 6510072, Japan
| | - Eisei Mitsuoka
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, Hyogo, 6510072, Japan
| | - Takashi Komatsubara
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, Hyogo, 6510072, Japan
| | - Seiji Shio
- Department of Gastroenterology, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, Hyogo, 6510072, Japan
| | - Masayuki Ishii
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, Hyogo, 6510072, Japan
| | - Hiroshi Higashiyama
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, Hyogo, 6510072, Japan
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Successful Endovascular Management of a Pseudoaneurysm of Replaced Right Hepatic Artery after Laparoscopic Cholecystectomy. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02936-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Singh P, Scibelli N, Gosal K, Bostick A, Morgan DC. Hepatic Artery Pseudoaneurysm Presenting as Gastrointestinal Hemorrhage. Cureus 2021; 13:e14190. [PMID: 33936900 PMCID: PMC8083905 DOI: 10.7759/cureus.14190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A hepatic artery pseudoaneurysm (HAP) is a rare complication of laparoscopic cholecystectomy. It can vary in its clinical presentation; however, given its severe nature, prompt assessment and management are crucial. We report a case of a 73-year-old male who underwent a laparoscopic cholecystectomy complicated by a right hepatic artery injury. This subsequently presented as a life-threatening case of upper gastrointestinal bleeding from HAP, with presumable hemobilia and septic shock from multiple liver abscesses. The diagnosis was made with computed tomography angiography (CTA) of the abdomen and pelvis followed by visceral angiography. The patient ultimately underwent a right hepatectomy for definitive treatment. The primary objective of this case is to highlight a less novel, though rare, case presentation and define a spectrum of treatment options available based on severity.
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Affiliation(s)
- Pratishtha Singh
- Internal Medicine, Grand Strand Regional Medical Center, Myrtle Beach, USA
| | | | - Kiranpreet Gosal
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Adam Bostick
- Pulmonary and Critical Care Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Dylan C Morgan
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
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Gandhi RJ, Gala KB, Gandhi AK. Role of Transarterial Embolization in the Management of Hepatic Artery Pseudoaneurysm Postlaparoscopic Cholecystectomy. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2020. [DOI: 10.1055/s-0040-1721533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Abstract
Purpose To assess the safety and effectiveness of transarterial embolization (TAE) in the management of hepatic artery pseudoaneurysms following laparoscopic cholecystectomy (LC).
Materials and Methods This is a retrospective study consisting of 13 patients who had undergone TAE for management of pseudoaneurysms of the hepatic artery or its branches following LC. Patients presented with symptoms such as hypotension, hematemesis, melena or gradual anemia post LC. Abdominal CT revealed hepatic artery pseudoaneurysm in all patients. TAE was performed with either coils or N-butyl cyanoacrylate or both. We evaluated technical and clinical effectiveness and complications of TAE.
Results TAE was successful both technically and in stopping bleeding in all patients (100% technical and clinical success). No patient had rebleeding after TAE. Four patients required laparotomy for draining hemoperitoneum and clots. Endoscopic retrograde cholangiopancreatography (ERCP) for hemobilia or bile duct injury was done in eight patients. Following TAE, hepatic infarct was observed in three patients. Postembolization syndrome was seen in four patients and one patient died due to sepsis.
Conclusions TAE is effective for treatment of hepatic artery pseudoaneurysms after LC. Hepatic infarcts and postembolization syndrome are the most common complications and can be managed conservatively.
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Affiliation(s)
- Rozil Jayesh Gandhi
- Department of Radiodiagnosis, Shardaben Municipality Hospital, Ahmedabad, Gujarat, India
| | - Kunal Bharat Gala
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai, India
| | - Aditi K. Gandhi
- Department of Radiodiagnosis, Shardaben Municipality Hospital, Ahmedabad, Gujarat, India
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Arata R, Yanagawa S, Miyata Y, Ishitobi T, Kodama S, Sumimoto K. Hemobilia after laparoscopic cholecystectomy that was successfully treated conservatively: Case report. Int J Surg Case Rep 2020; 77:307-310. [PMID: 33197773 PMCID: PMC7677667 DOI: 10.1016/j.ijscr.2020.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 11/18/2022] Open
Abstract
Hemobilia from pseudoaneurysm rupture after laparoscopic cholecystectomy is rare. Due to consequent rapid hemodynamic instability, it could be life threatening. Non-contrast CT and ERCP examinations were performed to confirm hemobilia diagnosis. Investigations revealed that there was no contrast agent leakage. Thus, our patient was treated conservatively as opposed to surgically.
Introduction Hemobilia due to pseudoaneurysm rupture is a rare, life-threatening complication of laparoscopic cholecystectomy (LC) that can cause rapid hemodynamic instability. Therefore, symptoms of hemobilia must be assessed carefully. Presentation of case An 88-year-old woman underwent LC in our hospital, and blood tests revealed elevation of hepatobiliary enzyme levels on postoperative day (POD) 12. Computed tomography (CT) showed a high absorption area in the common bile duct (CBD), and a diagnosis of hemobilia and a pseudoaneurysm without active bleeding into the abdominal cavity was made. There was no leakage of contrast medium outside the CBD during endoscopic retrograde cholangiography; thus, an endoscopic nasobiliary drainage (ENBD) tube was inserted on POD 12 and an endoscopic retrograde biliary drainage (ERBD) stent was placed in the CBD on POD 13. Thereafter, hepatobiliary enzyme levels gradually normalized and the ENBD tube and ERBD stent were removed on POD 27 and POD 54, respectively. The patient was discharged on POD 66. Discussion Hemostasis establishment using surgery or intervention radiology is often required for the treatment of hemobilia due to pseudoaneurysms; however, conservative treatment was effective in our case and we were able to pursue a minimally invasive approach. Erosion due to clip penetration or incomplete clipping of the cystic artery or its branches during surgery may have caused the cystic artery pseudoaneurysm. Conclusion Hemobilia could be life threatening and cause acute hemodynamic instability; therefore, prompt diagnosis is required. Although the frequency of complication is low, the possibility of hemobilia after LC should be considered.
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Affiliation(s)
- Ryosuke Arata
- Department of Surgery, Yoshida General Hospital, Japan
| | | | - Yasushi Miyata
- Department of Internal Medicine, Yoshida General Hospital, Japan
| | | | - Shinya Kodama
- Department of Surgery, Yoshida General Hospital, Japan
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Cui L, Kong L, Bai YH, Li XH, Wang XQ, Hao JJ, Duan F. Covered stent placement for hepatic artery pseudoaneurysm. Abdom Radiol (NY) 2020; 45:3337-3341. [PMID: 32095858 DOI: 10.1007/s00261-020-02452-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of covered stent placement for the treatment of hepatic artery pseudoaneurysm (HAP). METHODS Between March 2006 and March 2019, 17 consecutive patients underwent emergency covered stent placement for treatment of HAP. There were 12 men and 5 women aged 24-71 years, with an average age of 49.4 years. Eleven patients had undergone Whipple procedure, 3 had hepatic abscess following hepatectomy, 2 had undergone hepatectomy under extracorporeal circulation, and 1 had received surgical exploration after a car accident. The average interval from surgical intervention to massive bleeding was 15.3 days (range: 6-35 days). After HAP was confirmed by angiography, 1-3 covered stent grafts (3-8 mm in diameter and 13 mm-5 cm in length) were implanted. Adequate drainage, anti-infection treatment, and symptomatic treatment were offered after stent placement, and no anticoagulation or antiplatelet drug was used. RESULTS The interventions were successful in all 17 patients. Angiography revealed pseudoaneurysms in common hepatic artery in 16 patients (in gastroduodenal artery stumps in 4 patients) and hemorrhage from a ruptured right hepatic artery in 1 patient. All patients were successfully implanted with 1-3 covered stent grafts. Bleeding was completely controlled in 12 patients (stent diameter: 4.5-8 mm). Four patients (stent diameter: 3-4.5 mm) experienced bleeding recurrence 1 h to 3 days after stent implantation, and type 1 endoleaks were identified during second angiography. Finally, these 4 patients died of multiple organ failure 2-10 days after embolization/blockage. The remaining patient suffered from abdominal hemorrhage again 2 weeks after stent implantation, and second angiography showed hemorrhage from a branch of the superior mesenteric artery; no bleeding occurred after embolization. Thirteen patients survived at discharge, and the average length of hospital stay was 26.53 days (range: 11-58 days). The average follow-up time was 23 months (range: 16-37 months), during which 6 patients died of tumor progression. No bleeding recurred during the follow-up period, and routine color Doppler ultrasound revealed that the common hepatic artery was patent and the blood flow was smooth at the stent implantation site. CONCLUSION Covered stent placement is a safe and effective alternative for treating HAP patients with high risk of severe complications after hepatic artery embolization. Larger stent grafts (> 4 mm in diameter) may achieve better prognosis.
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Affiliation(s)
- Li Cui
- Department of Interventional Radiology, The General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Lu Kong
- The General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Yan-Hua Bai
- Department of Interventional Radiology, The General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Xiao-Hui Li
- Department of Interventional Radiology, The General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Xiu-Qi Wang
- Department of Interventional Radiology, The General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | | | - Feng Duan
- Department of Interventional Radiology, The General Hospital of Chinese People's Liberation Army, Beijing, 100853, China.
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Das M, Volmar FH, Walayat S, Nolte R. Hemobilia from a right hepatic artery pseudoaneurysm due to chronic cholecystitis. SAGE Open Med Case Rep 2019; 7:2050313X19872075. [PMID: 31489197 PMCID: PMC6710687 DOI: 10.1177/2050313x19872075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/31/2019] [Indexed: 11/22/2022] Open
Abstract
Splanchnic pseudoaneurysms are rare causes of hemobilia. Specifically, hepatic artery pseudoaneurysms from infectious or inflammatory etiology are even more rare. In this article, we describe our encounter with a 72-year-old female presenting with obstructive jaundice and acute blood loss anemia. Upper endoscopy indicated hemobilia and endoscopic retrograde cholangiopancreatography was completed with stent in place. Post endoscopic retrograde cholangiopancreatography, computed tomography angiogram indicated a right hepatic artery pseudoaneurysm which was the cause of her hemobilia. The patient was ultimately treated with selective coil embolization and interval cholecystectomy.
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Affiliation(s)
- Manjusha Das
- Division of Gastroenterology and Hepatology, College of Medicine, University of Illinois, Peoria, IL, USA
| | - Fritz-Henry Volmar
- Division of Gastroenterology and Hepatology, College of Medicine, University of Illinois, Peoria, IL, USA
| | - Saqib Walayat
- Department of Internal Medicine, College of Medicine, University of Illinois, Peoria, IL, USA
| | - Ryan Nolte
- Department of Cardiovascular Medicine and Surgery, OSF Saint Francis Medical Center, Peoria, IL, USA
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Pouwels S, Kanters C, le Haen PA, Poelman M. Acute biliary pancreatitis masking haemobilia due to a false aneurysm of the right hepatic artery after laparoscopic cholecystectomy. BMJ Case Rep 2018; 2018:bcr-2017-223137. [PMID: 30115707 DOI: 10.1136/bcr-2017-223137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Laparoscopic cholecystectomy is a commonly performed surgical procedure. The postoperative course is often uncomplicated; however, complications like infection, biliary leakage, and bleeding and bile duct injury can occur. Here we report on a patient with common bile duct obstruction and haemobilia due to a false aneurysm of the right hepatic artery after laparoscopic cholecystectomy, masked by biliary pancreatitis, complicated by an infarction of the liver after embolisation. The aetiology of upper gastrointestinal bleeding greatly varies. This case is an uncommon case of gastrointestinal bleeding due to a false aneurysm of the right hepatic artery, which was successfully treated.
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Affiliation(s)
- Sjaak Pouwels
- Surgery, Franciscus Gasthuis & Vietland, Rotterdam/ Schiedam, The Netherlands
| | - Corne Kanters
- Department of Surgery, Franciscus Gasthuis & Vlietland, Schiedam, The Netherlands
| | - Pum A le Haen
- Department of Radiology, Franciscus Gasthuis & Vlietland, Schiedam, The Netherlands
| | - Marijn Poelman
- Department of Surgery, Franciscus Gasthuis & Vlietland, Schiedam, The Netherlands
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