Hemobilia Due to an Iatrogenic Arteriobiliary Fistula Complicating Laparoscopic Cholecystectomy: A Case Report

Abstract

Hemobilia is the result of a pathological communication between bile duct and intra or extrahepatic vessel. 40% to 60% of the haemobilia cases are Iatrogenic, and the other causes are either vascular malformations or hepatic blunt trauma. We describe the case history of a patient in which laparoscopic cholecystectomy was complicated 3 months later by massive hemobilia. The cause of haemorrhage was a fistula between the principal bil duct and the right hepatic artery. This complication was successfully managed by surgery and angiographic embolization with full recovery of the patient.

Hemobilia due to arteriobiliary fistula complicating ERCP for residual bile duct stone in a case of Mirizzi syndrome

“…Selective angiography is the gold standard to identify and stop the bleeding by embolizing the offending vessel. 1 2 3 4 5 Angiography, however, failed to demonstrate the contrast leak in our patient, possibly because of the intermittent nature of the bleeding and the absence of a pseudoaneurysm. Because the patient had a large residual stone in the cystic duct stump protruding into the bile duct which caused recurrent jaundice, we proceeded with surgery.…”

“…The priority is to localize and stop the bleeding. Selective angiography is the gold standard to identify and stop the bleeding by embolizing the offending vessel 12345. Angiography, however, failed to demonstrate the contrast leak in our patient, possibly because of the intermittent nature of the bleeding and the absence of a pseudoaneurysm.…”

“…Hemobilia classically presents with Quinckes triad of bilary colic, jaundice and gastrointestinal bleeding; however the complete triad is seen in fewer than 40% of patients. 3 Most cases occur after medical interventions such as percutaneous liver biopsy, transhepatic cholangiography, and ERCP guide wire and stent placements. 1 2 In addition, blunt or penetrating liver trauma can cause hemobilia.…”

Symptomatic pseudoaneurysms following laparoscopic cholecystectomy

“…We found 97 eligible studies and a sum of 134 patients who presented with at least one symptomatic PA following LC during a 26-year period (1994–2020). [ 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 …”

Delayed hemobilia due to hepatic artery pseudo-aneurysm: a pitfall of laparoscopic cholecystectomy

“… Months Exploratory laparotomy Well at 6 months. AD Mate et al, [ 32 ] 45 years M LGIB HPA 15 days Emergency laparotomy NA El Bouhaddouti, et al [ 33 ] 50 years M Pain, jaundice and UGIB UGI endoscopy & HPA 3 months Emergent laparotomy. 1 year Thamer A. Bin Traiki et al [ 34 ] 65 years M Febrile (38.9 °C, (left brachial vein Thrombosis).…”