Pseudoaneurysma der Arteria hepatica sinistra als Komplikation einer ERCP mit Sphinkterotomie

Abstract

A pseudoaneurysm of the hepatic artery is a rare complication of interventional endoscopy or transhepatic puncture. The present case report describes a symptomatic pseudoaneurysm of the left hepatic artery following endoscopic retrograde cholangio-pancreatography (ERCP). The indication was a biliary pancreatitis, and it was treated by guide-wire-sphincterotomy and extraction of sludge with a Dormia basket. A superselective angiographic embolization was not necessary because of a spontaneous thrombotic obstruction of the pseudoaneurysm.

Left hepatic artery pseudoaneurysm complicating endoscopic retrograde cholangiopancreatography: A case report

“…Complications of ERCP are divided into those related to sedation, endoscopy, cannulation and contrast medium injection and therapeutic procedures[ 6 ]. Pseudoaneurysms developing from the branches of hepatic artery following ERCP are rarely reported[ 3 - 5 ], in those cases, one patient had a history of plastic stent implantation, the author consider hepatic pseudoaneurysm might have formed as a result of traumatic stimulation related to the stent placement, because it had been placed improperly and its tip located at the site of the aneurysm[ 4 ]. Another patient had cholangitis and underwent a open cholecystectomy, which might be implicated in the information of the false aneurysm[ 7 ].…”

“…Rarely[ 1 ], significant bleeding may occur secondary to the injury to the branches of the gastroduodenal artery. Although secondary hemorrhage from pseudoaneurysms developed in the branches of the gastroduodenal artery or pancreatoduodenal artery have been reported[ 2 - 4 ], Pseudoaneurysms developing from the branches of hepatic artery following ERCP are rarely reported[ 3 - 5 ], and most pseudoaneurysms are suspected associated with stent insertion or endoscopic sphincterotomy or inflammatory etiologies such as pancreatitis. We report one case of a 73-year-old man who underwent ERCP for relieving cholangitis and stone removal, and subsequently developed intra-abdominal hemorrhage secondary to a left hepatic artery pseudoaneurysm, which was managed successfully with embolization.…”

Emergency right hepatectomy after laparoscopic tru-cut liver biopsy

“…Intrahepatic arterial pseudo-aneurysms have been reported after multiple conditions, such as hepatic trauma [13] , derivative procedures such as porto-systemic shunts [14] , amebic abscess [15] , endoscopic retrograde cholangiopancreatography [16,17] , liver transplantation [18] , and thoracocentesis [19] . In regard to clinical manifestations, pseudo-aneurysms can be clinically silent; although they can present with vague, non-specific abdominal pain to a life-threatening massive hemorrhage.…”

Visceral Arterial Aneurysms Complicating Endoscopic Retrograde Cholangiopancreatography

“…VAA formation is considered a very rare complication of ERCP, directly resulting from traumatic injury to the visceral arteries during pancreaticobiliary manipulations or indirectly from pancreatitis. Very few cases reports of ERCP directly leading to formation of VAA have been reported [9, 10]. However, all these cases involved maneuvers like sphincterotomy or stent placement being performed.…”