Hepatic Artery Pseudoaneurysm Presenting With Mirizzi Syndrome and Hemobilia

Lin, Shuai‐Chun; Tseng, Chih‐Wei; Chen, Chun–Chia

doi:10.1016/j.cgh.2009.06.003

Cited by 9 publications

(7 citation statements)

References 3 publications

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“…The priority is to localize and stop the bleeding. Selective angiography is the gold standard to identify and stop the bleeding by embolizing the offending vessel 12345. Angiography, however, failed to demonstrate the contrast leak in our patient, possibly because of the intermittent nature of the bleeding and the absence of a pseudoaneurysm.…”

Section: Discussionmentioning

confidence: 64%

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Hemobilia due to arteriobiliary fistula complicating ERCP for residual bile duct stone in a case of Mirizzi syndrome

Mathur¹,

Thapar²,

Chowda³

2017

Ann Hepatobiliary Pancreat Surg

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Hemobilia is a rare cause of upper gastrointestinal tract bleeding. Most cases are iatrogenic following medical interventions, most commonly liver biopsy and transhepatic cholangiography. We present a case of arteriobiliary fistula between the right hepatic artery and the common hepatic duct, in a case of Mirrizi syndrome, following endoscopic biliary stenting and presenting with hemobilia. The patient was treated by surgical disconnection of the fistula, ligation of the right hepatic artery, and bilioenteric anastomosis.

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Section: Discussionmentioning

confidence: 64%

“…In addition, blunt or penetrating liver trauma can cause hemobilia 1. Other causes include bile duct stones, biliary varices, benign and malignant tumors of the bile duct, liver surgery and transplantation, congenital or acquired vascular aneurysms and hepatitis 1245…”

Section: Discussionmentioning

confidence: 99%

Hemobilia due to arteriobiliary fistula complicating ERCP for residual bile duct stone in a case of Mirizzi syndrome

Mathur¹,

Thapar²,

Chowda³

2017

Ann Hepatobiliary Pancreat Surg

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“…In an “open” case, the HAA was discovered during cholecystectomy. 14 An accidental rupture was sutured and embolisation was planned 2 days later. Another open case described a large HAA originating from the common and proper HA and the GDA, with an aberrant LHA.…”

Section: Resultsmentioning

confidence: 99%

Unsuccessful Stent Graft Repair of a Hepatic Artery Aneurysm Presenting with Haemobilia: Case Report and Comprehensive Literature Review

Gao

Jonge

Verhagen

et al. 2021

EJVES Vascular Forum

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Aims To discuss treatment strategies for non-traumatic, non-iatrogenic hepatic artery aneurysms (HAAs) in the presence of an arteriobiliary fistula, illustrated by a case and followed by a comprehensive review of the literature. Methods Following the PRISMA guidelines, 24 eligible HAA cases presenting with haemobilia were identified. Characteristics of patients, aneurysms, treatment strategies and their outcomes were collected. Results A 69 year old patient with no previous hepatobiliary intervention or trauma, presented with jaundice and haemobilia caused by a HAA. Initial treatment by endovascular stenting was chosen to prevent ischaemic liver complications. Unfortunately, this strategy failed because of stent migration due to ongoing infection leading to a type 1A endoleak. The patient had to be converted to open surgery with ligation of the HAA. The patient recovered uneventfully and no complications occurred during the following 12 months. Comprehensive literature review Of the 24 cases, nine had a true HAA and 15 were pseudo/mycotic aneurysms, mainly caused by endocarditis or cholecystitis. The majority were located in the right hepatic artery. In 20 cases, an endovascular first approach was chosen with embolisation, none with covered stents. Three of these cases had to be converted to open surgery because of rebleeding. In all open (primary or secondary) cases, ligation of the HAA was performed. One patient in these series died. No liver ischaemia or abscesses were reported, although one patient developed an ischaemic gallbladder. Conclusions Patients who present with a HAA and haemobilia may be treated safely by embolisation or open ligation. Using a covered stent graft in these patients can cause problems due to ongoing infection and should be monitored closely by imaging. Publication bias and lack of long term follow up imply cautious interpretation of these findings.

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“…Liver and biliary surgery [4,8,9,11], percutaneous liver biopsy [4,12], percutaneous liver tumor ablation [21], and percutaneous transhepatic biliary drainage and stent placement [4,7,10,20] contribute to the other causes of traumatic hemobilia. Nontraumatic causes of hemobilia include aneurysm or pseudoaneurysm caused by liver abscess [13], choledocholithiasis and related infection [14,23], pancreatitis [5,12,15,16,18], and tumor [16-19,22]. However, to the best of our knowledge, there are no previous reports in the English literature regarding hepatic pseudoaneurysm associated hemobilia after T-tube choledochostomy.…”

Section: Discussionmentioning

confidence: 99%

“…There are several causes of hemobilia which might be classified as traumatic [3-12] or nontraumatic [12-19]. Hemobilia caused by pseudoaneurysm might be due to abdominal trauma [2], liver and biliary surgery [8,9,11], percutaneous interventional hepatobiliary procedures [7,10,12,20,21], tumor [16-19,22] or other infectious processes such as liver abscess [13], cholecystitis [23], cholangitis [17], and pancreatitis [5,12,17]. To our knowledge, there are no previous reports pertaining to hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy.…”

Section: Introductionmentioning

confidence: 99%

Life-threatening hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy: report of a case

Lee

Chen

et al. 2010

BMC Gastroenterol

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BackgroundHemobilia is a rare but lethal biliary tract complication. There are several causes of hemobilia which might be classified as traumatic or nontraumatic. Hemobilia caused by pseudoaneurysm might result from hepatobiliary surgery or percutaneous interventional hepatobiliary procedures. However, to our knowledge, there are no previous reports pertaining to hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy.Case presentationA 65-year-old male was admitted to our hospital because of acute calculous cholecystitis and cholangitis. He underwent cholecystectomy, choledocholithotomy via a right upper quadrant laparotomy and a temporary T-tube choledochostomy was created. However, on the 19th day after operation, he suffered from sudden onset of hematemesis and massive fresh blood drainage from the T-tube choledochostomy. Imaging studies confirmed the diagnosis of pseudoaneurysm associated hemobilia. The probable association of T-tube choledochostomy with pseudoaneurysm and hemobilia is also demonstrated. He underwent emergent selective microcoils emobolization to occlude the feeding artery of the pseudoaneurysm.ConclusionsPseudoaneurysm associated hemobilia may occur after T-tube choledochostomy. This case also highlights the importance that hemobilia should be highly suspected in a patient presenting with jaundice, right upper quadrant abdominal pain and upper gastrointestinal bleeding after liver or biliary surgery.

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Hepatic Artery Pseudoaneurysm Presenting With Mirizzi Syndrome and Hemobilia

Cited by 9 publications

References 3 publications

Hemobilia due to arteriobiliary fistula complicating ERCP for residual bile duct stone in a case of Mirizzi syndrome

Hemobilia due to arteriobiliary fistula complicating ERCP for residual bile duct stone in a case of Mirizzi syndrome

Unsuccessful Stent Graft Repair of a Hepatic Artery Aneurysm Presenting with Haemobilia: Case Report and Comprehensive Literature Review

Life-threatening hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy: report of a case

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