Hemobilia Due to Cystic Artery Pseudoaneurysm: A Rare Late Complication of Laparoscopic Cholecystectomy

Badillo, Ricardo; Darcy, Michael D.; Kushnir, Vladimir

doi:10.14309/crj.2017.38

Cited by 8 publications

(7 citation statements)

References 11 publications

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“…However, she had a history of LC three years prior to admission. In LC, vascular injury can be caused by the mechanical maneuvers during surgical clip placement or cystic duct resection, by erosion of the blood vessels by the clip itself, or by heat (thermal injury) directly from the cauterization or indirectly transferred by the clip [ 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report

et al. 2021

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Background Hemobilia is a rare cause of upper gastrointestinal bleeding that originates from the biliary tract. It is infrequently considered in diagnosis, especially in the absence of abdominal trauma or history of hepatopancreatobiliary procedure, such as cholecystectomy, which can cause arterial pseudoaneurysm. Prompt diagnosis is crucial because its management strategy is distinct from other types of upper gastrointestinal bleeding. Here, we present a case of massive hemobilia caused by the rupture of a gastroduodenal artery pseudoaneurysm in a patient with a history of laparoscopic cholecystectomy 3 years prior to presentation. Case presentation A 44-year-old Indonesian female presented to the emergency department with complaint of hematemesis and melena accompanied by abdominal pain and icterus. History of an abdominal trauma was denied. However, she reported having undergone a laparoscopic cholecystectomy 3 years prior to presentation. On physical examination, we found anemic conjunctiva and icteric sclera. Nonvariceal bleeding was suspected, but esophagogastroduodenoscopy showed a blood clot at the ampulla of Vater. Angiography showed contrast extravasation from a gastroduodenal artery pseudoaneurysm. The patient underwent pseudoaneurysm ligation and excision surgery to stop the bleeding. After surgery, the patient’s vital signs were stable, and there was no sign of rebleeding. Conclusion Gastroduodenal artery pseudoaneurysm is a rare complication of laparoscopic cholecystectomy. The prolonged time interval, as compared with other postcholecystectomy hemobilia cases, resulted in hemobilia not being considered as an etiology of the gastrointestinal bleeding at presentation. Hemobilia should be considered as a possible etiology of gastrointestinal bleeding in patients with history of cholecystectomy, regardless of the time interval between the invasive procedure and onset of bleeding.

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Section: Discussionmentioning

confidence: 99%

Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report

et al. 2021

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“…Literature describes haemobilia to be associated with cholecystectomy and cholecystectomy-related-injury [ 2 , 8 ]. Inappropriate use of thermal or mechanical energy during dissection of Calot’s triangle has been described as a possible explanation [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pseudoaneurysms causing haemobilia have been described to present shortly after laparoscopic cholecystectomy or after cholecystitis [ 2 ]. Only one case reports a patient suffering from haemobilia 15 months after laparoscopic cholecystectomy [ 8 ]. Therefore, a 3-year follow-up should be considered a reasonable follow-up time since the chances of recurrence can be considered significantly small.…”

Section: Discussionmentioning

confidence: 99%

A pseudoaneurysm of the right hepatic artery treated successfully with a stent graft – A case report

Traa

Hoven-Gondrie

Diederik

2020

International Journal of Surgery Case Reports

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Highlights Haemobilia caused by pseudoaneurysms of the right hepatic artery or the cystic artery are rare with incidences up to 0.6%. Pathogenesis of pseudoaneurysms of the cystic or hepatic arteries are described to be cholecystectomy or cholecystitis related. Embolization is considered the golden standard. However, stent grafts should be considered a minimal invasive and effective alternative after failed embolization in pseudoaneurysms.

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“…It is well known that bile can precipitate endothelial damage to blood vessels, and iatrogenic injury that occurs to both the arterial and biliary structures can lead to delayed healing and the formation of pseudoaneurysms . The majority of pseudoaneurysms in the context of hemobilia appear to affect the right hepatic artery …”

Section: Causes Of Hemobiliamentioning

confidence: 99%

Hemobilia: Historical overview, clinical update, and current practices

Zhornitskiy

Berry

Han

et al. 2019

Liver International

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Hemobilia refers to macroscopic blood in the lumen of the biliary tree. It represents an uncommon, but important, cause of gastrointestinal bleeding and can have potentially lethal sequelae if not promptly recognized and treated. The earliest known reports of hemobilia date to the 17th century, but due to the relative rarity and challenges in diagnosis of hemobilia, it has historically not been well‐studied. Until recently, most cases of hemobilia were due to trauma, but the majority now occur as a sequela of invasive procedures involving the hepatopancreatobiliary system. A triad (Quincke's) of right upper quadrant pain, jaundice and overt gastrointestinal bleeding has been classically described in hemobilia, but it is present in only a minority of patients. Therefore, prompt diagnosis depends critically on a high index of suspicion based on a patient's clinical presentation and a history of recently undergoing hepatopancreatobiliary intervention or having other predisposing factors. Treatment of hemobilia depends on the suspected source and clinical severity and thus ranges from supportive medical care to urgent advanced endoscopic, interventional radiologic, or surgical intervention. In the present review, we provide a historical perspective, clinical update and overview of current trends and practices pertaining to hemobilia.

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Hemobilia Due to Cystic Artery Pseudoaneurysm: A Rare Late Complication of Laparoscopic Cholecystectomy

Cited by 8 publications

References 11 publications

Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report

Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report

A pseudoaneurysm of the right hepatic artery treated successfully with a stent graft – A case report

Hemobilia: Historical overview, clinical update, and current practices

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