Hemobilia from a right hepatic artery pseudoaneurysm due to chronic cholecystitis

Das, Manjusha; Volmar, Fritz-Henry; Walayat, Saqib; Nolte, Ryan N.

doi:10.1177/2050313x19872075

Cited by 7 publications

(7 citation statements)

References 19 publications

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“… Unknown, degenerative Unknown No Common HA, proper HA and GDA (Left HA originated from the left GA) Surgical Right PV embolisation for left liver hypertrophy followed by resection of the aneurysm without initially planned right hepatectomy None None 2017 Bacalbasa 23 66 M Unknown, degenerative Unknown Yes Right HA Endovascular Embolisation: polyvinyl alcohol particles, gelaspone and detachable spirals Pancreatitis and retrograde filling of HAA and PV rupture 3 weeks Open resection HAA and segment of PV with roux and Y, complicated by abscess subhepatic which was drained 3 months 2018 Delgado 24 65 M Endocarditis “Small” No Right HA Endovascular Embolisation: n.s. None None 2018 Fong 25 34 F Endocarditis 2.8 Yes Right HA Endovascular Embolisation: coils and thrombin None None 2018 Warren 26 53 F Endocarditis 1.8 Yes Right HA Endovascular Embolisation: coils None 4 days 2019 Das 27 72 F Unknown Unknown Yes Right HA Endovascular Embolisation: coils None None 2019 Zhu 28 28 F Endocarditis 30 No Proper HA and left HA …”

Section: Resultsmentioning

confidence: 99%

Unsuccessful Stent Graft Repair of a Hepatic Artery Aneurysm Presenting with Haemobilia: Case Report and Comprehensive Literature Review

Gao

Jonge

Verhagen

et al. 2021

EJVES Vascular Forum

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Aims To discuss treatment strategies for non-traumatic, non-iatrogenic hepatic artery aneurysms (HAAs) in the presence of an arteriobiliary fistula, illustrated by a case and followed by a comprehensive review of the literature. Methods Following the PRISMA guidelines, 24 eligible HAA cases presenting with haemobilia were identified. Characteristics of patients, aneurysms, treatment strategies and their outcomes were collected. Results A 69 year old patient with no previous hepatobiliary intervention or trauma, presented with jaundice and haemobilia caused by a HAA. Initial treatment by endovascular stenting was chosen to prevent ischaemic liver complications. Unfortunately, this strategy failed because of stent migration due to ongoing infection leading to a type 1A endoleak. The patient had to be converted to open surgery with ligation of the HAA. The patient recovered uneventfully and no complications occurred during the following 12 months. Comprehensive literature review Of the 24 cases, nine had a true HAA and 15 were pseudo/mycotic aneurysms, mainly caused by endocarditis or cholecystitis. The majority were located in the right hepatic artery. In 20 cases, an endovascular first approach was chosen with embolisation, none with covered stents. Three of these cases had to be converted to open surgery because of rebleeding. In all open (primary or secondary) cases, ligation of the HAA was performed. One patient in these series died. No liver ischaemia or abscesses were reported, although one patient developed an ischaemic gallbladder. Conclusions Patients who present with a HAA and haemobilia may be treated safely by embolisation or open ligation. Using a covered stent graft in these patients can cause problems due to ongoing infection and should be monitored closely by imaging. Publication bias and lack of long term follow up imply cautious interpretation of these findings.

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Section: Resultsmentioning

confidence: 99%

Unsuccessful Stent Graft Repair of a Hepatic Artery Aneurysm Presenting with Haemobilia: Case Report and Comprehensive Literature Review

Gao

Jonge

Verhagen

et al. 2021

EJVES Vascular Forum

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“…On our selective hepatic artery arteriography, pseudoaneurysm starts from the front branch of the right hepatic artery. A rupture of HAP is a very rare cause of hemobilia and occurs usually 4 weeks following the iatrogenic injury ( 14 , 15 ). In the present case, the boy also presented with hemobilia 1 month after undergoing a laparoscopic hepatic rupture repair.…”

Section: Discussionmentioning

confidence: 99%

Case report: Recurrent hemobilia due to hepatic artery pseudoaneurysm mimicking gastrointestinal tract bleeding

Wang

Yang²,

Xu³

et al. 2023

Front. Med.

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Hemobilia, a rare form of upper gastrointestinal bleeding (UGIB), is a potentially fatal complication that usually occurs after iatrogenic hepatobiliary trauma. However, hemobilia is clinically challenging to diagnose and often gets too late to diagnose. We herein report a case of recurrent hemobilia due to hepatic artery pseudoaneurysm (HAP) that was initially misdiagnosed as gastrointestinal tract bleeding. However, the patient was treated successfully with percutaneous coil occlusion of the pseudoaneurysm. This case illustrates that hemobilia can present as a mimic of gastrointestinal tract bleeding, but this is often difficult to diagnose at first glance and often misleads clinicians, especially emergency physicians, into making an incorrect diagnosis. Familiarity with the clinical features of hemobilia can help raise clinical suspicion and facilitate the early diagnosis and treatment of hemobilia.

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“…Author details 1 Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo 173-8606, Japan. 2 Department of Pathology, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-Ku, Tokyo 173-8606, Japan.…”

Section: Declarations Consent For Publicationmentioning

confidence: 99%

“…Hemobilia is caused by iatrogenic factors, trauma, and neoplasms, and other causes are rare [ 1 ]. Although there have been few case reports, hemobilia can be caused by chronic inflammation or arteriovenous malformation [ 2 , 3 ]. The most common cause of hemobilia due to chronic inflammation is bile duct stones.…”

Section: Introductionmentioning

confidence: 99%

A case with massive hemobilia long-term after internal drainage surgery for congenital biliary dilation

et al. 2021

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Background Currently, there is an unwavering consensus that the standard surgery for congenital biliary dilation (CBD) is extrahepatic bile duct resection and choledochojejunostomy. However, decades prior, choledochocyst–gastrointestinal anastomosis without extrahepatic bile duct resection (internal drainage surgery, IDS) was preferred for CBD because of its simplicity. Currently, there is almost no chance of a surgeon encountering a patient who has undergone old-fashioned IDS, which has been completely obsolete due to the risk of carcinogenesis from the remaining bile duct. Moreover, the pathological condition long after IDS is unclear. Herein, we report a case of life-threatening bile duct bleeding as well as carcinoma of the bile duct 62 years after IDS in a patient with CBD. Case presentation An 82-year-old Japanese woman with hemorrhagic shock due to gastrointestinal bleeding was transferred to our hospital. She had a medical history of unspecified surgery for CBD at the age of 20. Based on imaging findings and an understanding of the historical transition of the surgical procedure for CBD, the cause of gastrointestinal bleeding was determined to be rupture of the pseudoaneurysm of the dilated bile duct that remained after IDS. Hemostasis was successfully performed by transcatheter arterial embolization (TAE) in an emergency setting. Then, elective surgery for extrahepatic bile duct resection and choledochojejunostomy was performed to prevent rebleeding. Pathological examination revealed severely and chronically inflamed mucosa of the bile duct. Additionally, cholangiocarcinoma (Tis, N0, M0, pStage 0) was incidentally revealed. Conclusion It has been indicated that not only carcinogenesis, but also a risk of life-threatening bleeding exists due to long-lasting chronic inflammation to the remnant bile duct after IDS for CBD. Additionally, both knowledge of which CBD operation was performed, and an accurate clinical history are important for the diagnosis of hemobilia.

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Hemobilia from a right hepatic artery pseudoaneurysm due to chronic cholecystitis

Cited by 7 publications

References 19 publications

Unsuccessful Stent Graft Repair of a Hepatic Artery Aneurysm Presenting with Haemobilia: Case Report and Comprehensive Literature Review

Unsuccessful Stent Graft Repair of a Hepatic Artery Aneurysm Presenting with Haemobilia: Case Report and Comprehensive Literature Review

Case report: Recurrent hemobilia due to hepatic artery pseudoaneurysm mimicking gastrointestinal tract bleeding

A case with massive hemobilia long-term after internal drainage surgery for congenital biliary dilation

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