Laparoscopic management of post-cholecystectomy sectoral artery pseudoaneurysm

Abstract

Vascular injuries during laparoscopic cholecystectomy can occur similar to biliary injuries and mostly represented by intraoperative bleeding. Hepatic artery system pseudoaneurysm are rare. It occurs in the early or late postoperative course. Patients present with pallor, signs of haemobillia and altered liver function. We report a case of right posterior sectoral artery pseudoaneurysm detected 2 weeks after laparoscopic cholecystectomy and successfully repaired laparoscopically. We also describe how laparoscopic pringle clamping saved the conversion. The actively bleeding right posterior sectoral artery pseudoaneurysm was diagnosed by CT angiogram. Embolisation, usually the treatment of choice, would have risked liver insufficiency as hepatic artery proper was at risk because the origin the bleeding artery was just after its bifurcation. Isolated right hepatic artery embolisation can also cause hepatic insufficiency. To our knowledge this is the first reported case of laparoscopic repair of post-laparoscopic cholecystectomy bleeding sectoral artery pseudoaneurysm.

An Unusual Life-Threatening Hemobilia Caused by Hepatic Pseudoaneurysm Following Choledochostomy: A Case Report

“…However, in the present case, we could not find any active bleeding or any abnormality site in the whole biliary tract by choledochoscope examination, which suggests that endoscope examination is not the best choice as a confirmation method to find the cause of all hemobilia. In fact, selective celiac and superior mesenteric artery angiography has shown to be more reliable in many cases [10]. In agree-ment with this, selective celiac angiography clearly revealed the two small hepatic pseudoaneurysms in our case.…”

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

“…40 Although in most cases a PSA is surgically treated using an open method, a recent report described the successful laparoscopic suture ligation of a PSA in the right posterior sector of the hepatic artery. 21 The initial inspection and manipulation of the PSA led to severe bleeding, which was adequately controlled with a vascular clamp using the laparoscopic Pringle manoeuvre. With a clearer view of the surrounding anatomy, laparoscopic ligation was performed by taking some of the periarterial tissue to prevent ligature slippage.…”

“…With a clearer view of the surrounding anatomy, laparoscopic ligation was performed by taking some of the periarterial tissue to prevent ligature slippage. 21 Following ligation of the RHA, the risk of a liver infarction is generally limited as blood flow is maintained by portal circulation. 26 In addition, revascularisation of the right liver lobe occurs due to the rapid development within the hilar plate of an omega-shaped collateral arterial circulatory system, originating from the preserved branch of the hepatic artery.…”

“…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,…”

Bronchial Artery Pseudoaneurysm With Major Hemorrhage After Bronchial Thermoplasty

“…Thermal injury has been hypothesized as a mechanism for development of pseudoaneurysms in other locations after various types of procedures. [10][11][12] Given the location of the patient's pseudoaneurysm and its temporal proximity to the procedure, its formation possibly resulted from a thermal vascular injury caused by the bronchial thermoplasty. Hypertension and anticoagulant therapy have also been associated with pseudoaneurysm formation.…”