Fatal Upper Gastrointestinal Bleeding Due to Hepatic Artery Pseudoaneurysm Diagnosed by Endoscopy

Abstract

We report a case of fatal gastrointestinal bleeding due to hepatic artery pseudoaneurysm diagnosed by means of endoscopy in a 66-year-old male who had undergone laparoscopic cholecystectomy the previous month. We think that the image is of remarkable interest and rarity.

Hepatic or Cystic Artery Pseudoaneurysms Following a Laparoscopic Cholecystectomy: Literature review of aetiopathogenesis, presentation, diagnosis and management

“…Among the cases which specified the gender or age of the patient, 45.2% were male and the age ranged from 12-81 years with a mean age of 49.8 years. 4,5,[9][10][11][12][13]15,[17][18][19][20][21][24][25][26][27][28][29][30][31][33][34][35][37][38][39][40][41][42][43][46][47][48]51,57,58,60,62 The time of presentation following the LC procedure ranged from six days to five years with a mean of 36 days. [3][4][5][7][8][9][10][11][12][13]15,…”

“…3,15,16,37,45 The overall mortality rate was 2.0% (n = 2). 7,40 One fatality was due to severe haemorrhagic relapse following repair of the PSA, resulting in irreversible hypovolaemic shock despite re-exploration and ligation. 40 In the second case, the patient died from a concomitant injury to the portal vein.…”

“…7,40 One fatality was due to severe haemorrhagic relapse following repair of the PSA, resulting in irreversible hypovolaemic shock despite re-exploration and ligation. 40 In the second case, the patient died from a concomitant injury to the portal vein. The true incidence of PSAs in the cystic/hepatic arteries is difficult to determine as many cases are asymptomatic and thus never detected.…”

“…4 However, the RHA is usually the most commonly involved vessel. 28,30,32,33,[39][40][41]57 Other involved sites include the cystic artery and, in some cases, the common hepatic and gastroduodenal arteries. 4,9,37,38,44,47,58 a e t i o pat h o g e n e s i s A PSA may arise due to multiple mechanisms of injury, including laceration, transection or occlusion of the blood vessels following a mechanical or thermal injury to the artery.…”

“…7 Erosion of a PSA into the cystic duct stump or GI tract forming a fistula between the two structures has been previously reported. 5,9,23,24,35,40 This could involve the duodenum, leading to haematemesis, the jejunum, for example in a patient presenting with lower GI bleeding who had previously undergone Roux-en-Y reconstruction following a stomach carcinoma, or hepatic flexure in a patient presenting with hematochezia. 23,24,35,40 In most patients (80%), the PSA usually presents approximately one month following the LC surgery; however, delayed PSA presentation as late as five years after the surgery has been reported.…”