Hemobilia After Laparoscopic Cholecystectomy

Wen, Feng; Dong, Yue; Lu, Zai Ming; Liu, Zhao Yu; Li, Wei; Guo, Qi

doi:10.1097/sle.0000000000000241

Cited by 14 publications

(7 citation statements)

References 30 publications

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“…20 Recent reports have discussed features of haemobilia on a CT scan, including the presence of a haematoma within the abdominal cavity and gallbladder fossae, high attenuation of blood clots within the bile duct, biliary dilatation, a PSA of the RHA, contrast extravasation, enhancement of the bile duct wall and hypoperfusion of the right lobe of the liver. 16,65 Catheter angiography can be both diagnostic and therapeutic. 18,20,29,31 Indications of a dilated cystic artery stump on an angiogram are considered ominous and may warrant embolisation, despite a lack of active bleeding during other investigations.…”

Section: 7 D I a G N O S T I C A N D T H E R A P E U T I C I N V E mentioning

confidence: 99%

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

Machado¹,

Alzadjali²,

Kakaria³

et al. 2017

SQUMJ

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Pseudoaneurysms (PSAs) of the hepatic and/or cystic artery are a rare complication following a laparoscopic cholecystectomy (LC). Generally, PSA cases present with haemobilia several weeks following the procedure. Transarterial embolisation (TAE) is considered the optimal management approach. We report a 70-year-old woman who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in 2016 with massive hemoperitoneum two weeks after undergoing a LC procedure in another hospital. She was successfully managed using coil TAE. An extensive literature review revealed 101 cases of hepatic or cystic artery PSAs following a LC procedure. Haemobilia was the main presentation (85.1%) and the mean time of postoperative presentation was 36 days. The hepatic artery was involved in most cases (88.1%), followed by the cystic artery (7.9%) and a combination of both (4.0%). Most cases were managed with TAE (72.3%), with a 94.5% success rate. The overall mortality rate was 2.0%.

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Section: 7 D I a G N O S T I C A N D T H E R A P E U T I C I N V E mentioning

confidence: 99%

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

Machado¹,

Alzadjali²,

Kakaria³

et al. 2017

SQUMJ

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“…Hemobilia due to pseudoaneurysm rupture may occur several years after the invasive procedure [ 9 ], but such cases are rare. The delayed onset could be due to a slowly progressing pseudoaneurysm but could result in a massive bleeding event [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Symptoms of hemobilia depend on the source and amount of bleeding, which could be hematemesis, melena, hematochezia, or a combination of these [ 10 , 11 ]. Postpercutaneous invasive procedure hemobilia is characterized by bleeding from the drainage catheter [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…CTA is capable of determining the location of bleeding but unable to determine severity of the bleeding [ 1 , 2 ]. CTA in patients with hemobilia will show contrast extravasation, blood clot in the biliary system, or vascular malformation [ 11 , 14 ]. The key advantages of CTA are its noninvasive nature, lower radiation exposure, and provision of a rapid result.…”

Section: Discussionmentioning

confidence: 99%

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Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report

et al. 2021

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Background Hemobilia is a rare cause of upper gastrointestinal bleeding that originates from the biliary tract. It is infrequently considered in diagnosis, especially in the absence of abdominal trauma or history of hepatopancreatobiliary procedure, such as cholecystectomy, which can cause arterial pseudoaneurysm. Prompt diagnosis is crucial because its management strategy is distinct from other types of upper gastrointestinal bleeding. Here, we present a case of massive hemobilia caused by the rupture of a gastroduodenal artery pseudoaneurysm in a patient with a history of laparoscopic cholecystectomy 3 years prior to presentation. Case presentation A 44-year-old Indonesian female presented to the emergency department with complaint of hematemesis and melena accompanied by abdominal pain and icterus. History of an abdominal trauma was denied. However, she reported having undergone a laparoscopic cholecystectomy 3 years prior to presentation. On physical examination, we found anemic conjunctiva and icteric sclera. Nonvariceal bleeding was suspected, but esophagogastroduodenoscopy showed a blood clot at the ampulla of Vater. Angiography showed contrast extravasation from a gastroduodenal artery pseudoaneurysm. The patient underwent pseudoaneurysm ligation and excision surgery to stop the bleeding. After surgery, the patient’s vital signs were stable, and there was no sign of rebleeding. Conclusion Gastroduodenal artery pseudoaneurysm is a rare complication of laparoscopic cholecystectomy. The prolonged time interval, as compared with other postcholecystectomy hemobilia cases, resulted in hemobilia not being considered as an etiology of the gastrointestinal bleeding at presentation. Hemobilia should be considered as a possible etiology of gastrointestinal bleeding in patients with history of cholecystectomy, regardless of the time interval between the invasive procedure and onset of bleeding.

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“…The advantages of contrast-enhanced CT include its non-invasive nature and low radiation exposure compared to conventional angiography, rapid results, and excellent diagnostic performance characteristics. 46,48,49…”

Section: Diagnosismentioning

confidence: 99%

Hemobilia: Etiology, diagnosis, and treatment

Berry

Han

Kardashian³

et al. 2018

Liver Research

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Hemobilia refers to bleeding from and/or into the biliary tract and is an uncommon but important cause of gastrointestinal hemorrhage. Reports of hemobilia date back to the 1600s, but due to its relative rarity and challenges in diagnosis, only in recent decades has hemobilia been more critically studied. The majority of cases of hemobilia are iatrogenic and caused by invasive procedures involving the liver, pancreas, bile ducts and/or the hepatopancreatobiliary vasculature, with trauma and malignancy representing the two other leading causes. A classic triad of right upper quadrant pain, jaundice, and overt upper gastrointestinal bleeding has been described (i.e. Quincke’s triad), but this is present in only 25%–30% of patients with hemobilia. Therefore, prompt diagnosis depends critically on having a high index of suspicion, which may be based on a patient’s clinical presentation and having recently undergone (peri-) biliary instrumentation or other predisposing factors. The treatment of hemobilia depends on its severity and suspected source and ranges from supportive care to advanced endoscopic, interventional radiologic, or surgical intervention. Here we provide a clinical overview and update regarding the etiology, diagnosis, and treatment of hemobilia geared for specialists and subspecialists alike.

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Hemobilia After Laparoscopic Cholecystectomy

Abstract: Gallbladder triangle anatomic variation and intraoperative adhesion were the risk factors for hemobilia after LC. Abdominal CT is a useful examination for the diagnosis. Transcatheter arterial embolization is the therapeutic option of choice.

Cited by 14 publications

References 30 publications

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

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

Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report

Hemobilia: Etiology, diagnosis, and treatment

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