Symptomatic pseudoaneurysms following laparoscopic cholecystectomy: Focus on an unusual and dangerous complication

An exploration of radiological signs in post-intervention liver complications

The advent and progression of radiological techniques in the past few decades have revolutionized the diagnostic and therapeutic landscape for liver diseases. These minimally invasive interventions, ranging from biopsies to complex therapeutic procedures like transjugular intrahepatic portosystemic shunt placement and transarterial embolization, offer substantial benefits for the treatment of patients with liver diseases. They provide accurate tissue diagnosis, allow real-time visualization, and render targeted treatment for hepatic lesions with enhanced precision. Despite their advantages, these procedures are not without risks, with the potential for complications that can significantly impact patient outcomes. It is imperative for radiologists to recognize the signs of these complications promptly to mitigate further health deterioration. Ultrasound, CT, and MRI are widely utilized examinations for monitoring the complications. This article presents an overarching review of the most commonly encountered hepatobiliary complications post-radiological interventions, emphasizing their imaging characteristics to improve patient post-procedure management.

Hepatic artery pseudoaneurysm: three case reports and literature review

Laparoscopic surgery is extensively applied in the treatment of hepatobiliary diseases. Hepatic artery pseudoaneurysm (HAP) is a rare complication following hepatic biliary surgery through laparoscopy. The clinical manifestations of HAP are diverse and can be fatal. Given its severity, rapid assessment and management are crucial to ensuring a good prognosis. Here, we report three cases of HAP; two underwent laparoscopic surgery due to cholelithiasis, and another caused by trauma. The first case exhibited a pseudoaneurysm involving the distal portion of the right hepatic artery main trunk. The second patient had a pseudoaneurysm at the bifurcation of the left and right hepatic arteries. The third case involved a patient with a pseudoaneurysm involving a branch of the right hepatic artery. The main clinical manifestations of all three cases were bleeding from the biliary tract (the first two cases showed postoperative bleeding in the T-tube, while the third case exhibited gastrointestinal bleeding). The final diagnosis was obtained through digital subtraction angiography. The three patients underwent successful transcatheter arterial embolization operation and a follow-up revealed they were disease-free and alive. This article aims to highlight a rare complication of laparoscopic hepatobiliary surgery and share our experience in early diagnosis and treatment of HAP.

Right Hepatic Artery Pseudoaneurysm Post-laparoscopic Cholecystectomy: A Case Report of Endovascular Stent-Graft Management

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.

Laparoscopic cholecystectomy after transcatheter arterial embolisation for haemobilia due to a pseudoaneurysm in the gallbladder: A case report

Pseudoaneurysms of the cystic artery are a rare but significant complication of acute cholecystitis. Laparoscopic cholecystectomy may be a safe alternative to open cholecystectomy in such cases. We report the case of a female patient in her seventies, who presented with anaemia, jaundice, and hepatic dysfunction during hospitalisation for right knee pyogenic arthritis. The patient had no pain in the right upper quadrant. Her serum haemoglobin level was 6.5 g/dL, and upper gastrointestinal endoscopy revealed no abnormalities. Six days later, jaundice worsened, and endoscopic retrograde cholangiopancreatography revealed bloody bile. An endoscopic biliary drainage tube was inserted at the discretion of the gastroenterology department. Contrast-enhanced computed tomography revealed a haematoma in the gallbladder and a pseudoaneurysm in the lateral wall of the gallbladder. On the same day, the endoscopic biliary drainage tube was replaced with an endoscopic nasobiliary drainage tube, which indicated the degree of haemorrhage and enabled lavage of the lumen in cases of obstruction. The next day, angiography revealed a pseudoaneurysm of the deep branch of the cystic artery and coil embolisation was performed at the periphery of the cystic artery. Uninterrupted laparoscopic cholecystectomy was performed. Although laparoscopic cholecystectomy is difficult when bleeding is uncontrolled, it was safely performed following haemostasis using transcatheter arterial embolisation. Laparoscopic cholecystectomy is feasible in haemodynamically stable patients with cystic artery pseudoaneurysms after transcatheter arterial embolisation.

Effectiveness and Clinical Value of Laparoscopic Cholecystectomy and Cholangiography in the Diagnosis of Biliary Calculi

Objective

To investigate the effectiveness and clinical value of cholangiography in the diagnosis of bile duct stones in laparoscopic cholecystectomy.

Methods

200 patients who underwent laparoscopic cholecystectomy in our hospital from January 2017 to January 2019 were randomly divided into research group and control group, with 100 cases in each group. The research group underwent choledochotomy and exploration with the help of choledochoscope, while the control group underwent cholangiography to diagnose bile duct stones. The cure rate, residual stone rate, complication rate, intraoperative bleeding, hospital stay and patient satisfaction were compared between the two groups.

Results

in the control group, 9 cases were converted to laparotomy, 20 cases of common bile duct stones, 10 cases of bile duct injury and 6 cases of common bile duct variation. In the research group, there were 2 cases of conversion to laparotomy, 12 cases of common bile duct stones, 2 cases of bile duct injury and 4 cases of common bile duct variation. The cure rate of the researchgroup was higher than that of the control group, There was significant difference between the two groups (P < 0.05). The residual amount of stones in the research group was lower than that in the control group, and there was significant difference between the two groups (P < 0.05). The incidence of postoperative complications in the research group was lower than that in the control group, and there was significant difference between the two groups (P < 0.05). The patient satisfaction in the research group was higher than that in the control group, and there was significant difference between the two groups (P < 0.05). The intraoperative blood output of the research group was lower than that of the observation group, and there was significant difference between the two groups (P < 0.05).

Conclusion

cholangiography is an effective method for the diagnosis of bile duct stones in laparoscopic cholecystectomy. Clarifying the variation and anatomical structure of bile duct is helpful to improve the surgical cure rate, reduce the residual rate of postoperative stones and the incidence of complications, reduce the amount of intraoperative bleeding, shorten the hospital stay, and promote the postoperative rehabilitation of patients.

Early Rupture of Iatrogenic Cystic Artery Pseudoaneurysm After Unsuccessful Laparoscopic Cholecystectomy: A Case Report

Laparoscopic cholecystectomy has been established as the gold-standard method to deal with symptomatic cholelithiasis and cholecystitis. Although, like any other surgical procedure, it may have complications that affect the mortality and morbidity of patients. More specifically, the cystic artery pseudoaneurysm is considered a rare complication of laparoscopic cholecystectomy, which despite its rarity, may be fatal for the patient. Herein, we present the case of a 67-year-old man with a ruptured iatrogenic cystic artery pseudoaneurysm in the early postoperative period after laparoscopic cholecystectomy that converted to open wherein a cholecystostomy catheter was placed. The patient was hospitalized in our surgical unit, and he was treated with cystic artery embolization initially and secondary with elective open cholecystectomy.