Hemobilia as a result of right hepatic artery pseudoaneurysm rupture: An unusual complication of laparoscopic cholecystectomy

Abstract

In cases of GI bleeding the awareness of the surgeon should be drawn to a clinical suspicion of hemobilia and an underlying hepatic artery pseudoaneurysm that can arise as a complication. CT angiography should be performed for early diagnosis and management in such patients.

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,…”

“…checking the patient's surgical history), an upper GI endoscopy, regular or Doppler ultrasonography, a contrast CT scan and/or an angiogram. 6,9,13,18,20,23,29,[33][34][35]37,53 Ultrasonography may lead to the detection of an aneurysm or fluid consistent with haemorrhage; however, the diagnostic accuracy of this option is directly related to the size of the PSA and the operator's experience. 13,16,25 Three-dimensional (3D) CT reconstruction or catheter angiography can also help to define the aneurysm and its feeding vessels.…”

“…With the advent of multidetector CT scans and advancements in 3D imaging software in the form of volume determination, CT is the preferred technique for primary vascular imaging among patients with suspected PSAs. 20 Recent reports have discussed features of haemobilia on a CT scan, including the presence of a haematoma within the abdominal cavity and gallbladder fossae, high attenuation of blood clots within the bile duct, biliary dilatation, a PSA of the RHA, contrast extravasation, enhancement of the bile duct wall and hypoperfusion of the right lobe of the liver. 16,65 Catheter angiography can be both diagnostic and therapeutic.…”

“…16,65 Catheter angiography can be both diagnostic and therapeutic. 18,20,29,31 Indications of a dilated cystic artery stump on an angiogram are considered ominous and may warrant embolisation, despite a lack of active bleeding during other investigations. 58 Nevertheless, angiography has certain diagnostic limitations which may be influenced by variable flow rate, intermittent bleeding at the time of investigation and hepatic artery abnormalities.…”

Hemobilia secundaria a aneurisma de la artera hepática

“…La esofagogastroduodenoscopia es el método diagnós-tico de elección porque, además de descartar otras causas de hemorragia, puede demostrar el flujo de sangre proveniente de la papila duodenal (12). Los estudios diagnósti-cos complementarios son la ultrasonografía (USG) abdominal, TAC abdominal contrastada, resonancia magnética nuclear (RMN) de abdomen y arteriografía selectiva.…”