Hemobilia following laparoscopic cholecystectomy: computed tomography findings and clinical outcome of transcatheter arterial embolization

Abstract

Abdominal CT provided direct signs that can aid in the diagnosis of hemobilia after LC. TAE allowed for successful treatment of hemobilia with minor complications.

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

“…6,7,42 Among the cases treated with TAE, complications included liver abscesses (n = 10; 13.7%), post-embolisation syndrome and hepatic ischaemia (n = 9; 12.3%),postoperative bleeding for a month (n = 1; 1.4%) and erosion of the stent into the common bile duct (CBD; n = 1; 1.4%). 3,15,16,37,45 The overall mortality rate was 2.0% (n = 2). 7,40 One fatality was due to severe haemorrhagic relapse following repair of the PSA, resulting in irreversible hypovolaemic shock despite re-exploration and ligation.…”

“…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.…”

“…6,9,13,18,20,23,29,[33][34][35]37,53 Ultrasonography may lead to the detection of an aneurysm or fluid consistent with haemorrhage; however, the diagnostic accuracy of this option is directly related to the size of the PSA and the operator's experience. 13,16,25 Three-dimensional (3D) CT reconstruction or catheter angiography can also help to define the aneurysm and its feeding vessels. With the advent of multidetector CT scans and advancements in 3D imaging software in the form of volume determination, CT is the preferred technique for primary vascular imaging among patients with suspected PSAs.…”

“…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.…”

“…6 However, due to significant advances in catheter-based therapies, PSAs are now primarily treated with TAE by occluding the sac or the feeding vessel with a variety of embolic agents, including gel foam, coils, N-butyl cyanoacrylate and thrombin, before ideally embolising the vessel distal and proximal to the PSA in order to prevent collateral filling of the PSA. 5,6,[15][16][17][18][19]22,23,25,37,43 When coils are used, they can induce thrombosis; hence, in patients with significant coagulopathies, the vessel may still remain patent despite embolisation and the procedure may be ineffective in controlling bleeding. In small PSAs, glue may be used instead as the adhesive conforms to the shape of PSA.…”