False aneurysm of a hepatic artery branch and a recurrent subphrenic abscess

Abstract

Although laparoscopic cholecystectomy has become a safe and effective alternative for open cholecystectomy as treatment of symptomatic cholelithiasis, it may be followed by different complications. Two cases are presented with unusual complications after laparoscopic cholecystectomy. One patient was readmitted 11 days after laparoscopic cholecystectomy with severe upper abdominal pain and a false aneurysm of a branch of the right hepatic artery. The other patient developed a recurrent subphrenic abscess 10 months after the initial operation, which eventually was shown to be caused by a lost gallstone. Although these are rare complications of laparoscopic cholecystectomy, they should be recognized as potential causes of recurrent abdominal pain, even months after the procedure.

Severe Hemobilia from Hepatic Artery Pseudoaneurysm

“…TAE of hepatic branches is the first line procedure, whereas open or laparoscopic surgery should be advocated only in case of unsuccessful coil embolization. TAE may be followed by rebleeding and require a second embolization or emergency laparotomy [2, 4, 7, 10, 12]. In the case presented, one single coil embolization of RHA obtained the definite management of haemorrhage.…”

“…Pseudoaneurysms are often close to surgical clips, and may reach 7 cm in size [12, 14, 15, 22, 26]; bile duct leaks may be associated, but clear visualization of the presence of an artero-biliary fistula by imaging radiologic techniques is seldom obtained. In more than 80% of cases, trans-arteriographic embolization (TAE) is the first and definite treatment; in some cases, reembolization is necessary [2, 4, 10, 18], whereas open or laparoscopic surgery ought to be chosen only in case of unsuccessful coil embolization or when embolization is impossible to accomplish [7, 12, 25]. The pathogenesis of this uncommon but sometimes fatal complication [9, 11] still remains unclear.…”

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

“…TAE may be followed by rebleeding and requires a second embolization or emergency laparotomy. 2,4,7,10,12 In the case presented, one single coil embolization of RHA could obtain the definite management of hemorrhage. To date, no definite pathogenetic explanation of hemobilia following LC has been given, but titanium clips are often found in the vicinity of pseudoaneurysms and generally monopolar coagulation is adopted by laparoscopic surgeons, hence mechanical and thermal injuries both to biliary and vascular structures have been considered responsible for this complication.…”

“…In more than 80% of cases, transarteriographic embolization (TAE) is the first and definite treatment; in some cases re-embolization is necessary, 2,4,10,18 while open or laparoscopic surgery ought to be chosen only in case of unsuccessful coil embolization or when embolization is impossible to accomplish. 7,12,25 The pathogenesis of this uncommon but sometimes fatal complication 9,11 still remains unclear. Mechanical or thermal injuries have been considered responsible, but at the moment precise suggestions to prevent hemobilia after LC are still lacking.…”

Life-threatening postoperative hemorrhage from hepatic artery pseudoaneurysm successfully treated by transcatheter embolization in a 5-year-old

“…Conditions such as leak of enteric contents/biliopancreatic secretions, intraabdominal infection, and intraoperative arterial injury, which are all possible after choledochal cyst operation, can predispose to pseudoaneurysm formation [7,10]. Trauma is also a known and reported cause of pseudoaneurysm in adults as well as in the pediatric population [11].…”