A rare complication of a common operation: hepatic artery pseudo aneurysm following cholecystectomy report of a case

Abstract

Though it is a rare complication, early diagnosis and treatment of postoperative pseudo aneurysm is essential to prevent life threatening bleeding.

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,…”

“…4 However, the RHA is usually the most commonly involved vessel. 28,30,32,33,[39][40][41]57 Other involved sites include the cystic artery and, in some cases, the common hepatic and gastroduodenal arteries. 4,9,37,38,44,47,58 a e t i o pat h o g e n e s i s A PSA may arise due to multiple mechanisms of injury, including laceration, transection or occlusion of the blood vessels following a mechanical or thermal injury to the artery.…”

“…4 Associations have also been reported between PSAs and intraoperative adhesions and anatomical variations of the ducts and cystic artery. 16,41,57 Major anatomical variations include a doubled cystic artery (20%), a "caterpillar hump" formation of the RHA and the unusual course of the cystic artery anterior to the CBD or common hepatic artery. 41,57 During a LC procedure, vessel injury can be avoided by adhering to basic surgical tenets, including performing the dissection in the plane closest to the gallbladder wall, retaining adequate view of the cystic artery and the duct entering the gallbladder before applying an energy source, freeing the infundibulum inferiorly to widen Calot's triangle (i.e.…”

“…7,15 In such cases, a LC carried out for acute cholecystitis or concomitant ductal injury may be a difficult and prolonged procedure. 4,6,18,30,31,37,41 p r e s e n tat i o n A PSA may present either in the initial days following a cholecystectomy or be delayed over weeks, months or, on rare occasions, years. 31,41 A delay in presentation following a thermal injury could be due to charring of a vessel which gets detached weeks later, particularly in the presence of bile.…”

Severe Hemobilia from Hepatic Artery Pseudoaneurysm after Laparoscopic Cholecystectomy: A Case Report and Review of Literature

“…Hemobilia may also occur after elective hepatobiliary surgery and emergency, open or converted cholecystectomy during which clips are never or seldom employed; instead, severe local inflammation may entail difficult dissection and thermal damage must be the real causes of inadvertent vascular injuries in such cases. [26][27][28][29][30] Pseudoaneurysms of hepatic or cystic artery can be even secondary to acute or chronic cholecystitis, [31][32][33] and perhaps in some cases this vascular lesion was present even before LC. The size of pseudoaneurysms increases with the time and may reach the noticeable size of 7 cm as observed when cholecystitis is managed nonoperatively for long time 22,31 or less frequently, when the vascular lesion complicates LC and becomes symptomatic much time later.…”