Right hepatic artery pseudoaneurysm and cystic duct leak after laparoscopic cholecystectom

Abstract

Laparoscopic cholecystectomy (LC) seems to be associated with an increased risk of biliary or vascular injuries. Hepatic artery pseudoaneurysms (HAP) are rare complications of LC. HAP can occur in the early or late postoperative period. Patients with HAP present with abdominal pain, hemobilia, and liver function test (LFT) alterations. We report the case of a patient who was affected with a cystic duct stump leak associated with a right HAP and was treated by endoscopic biliary drainage and angiographic coil embolization.

Low conjunction of the cystic duct with the common bile duct: does it correlate with the formation of common bile duct stones?

“…Therefore, it is used increasingly in the treatment of patients with gallstone disease. The overall complication rate reaches 5.1% and includes cystic duct leakage, biliary obstruction, or late onset stricture caused by partial or complete hepatic or common duct ligation, retained cystic/bile duct stones, right hepatic artery pseudoaneurysm, and malposition of T-tubes in the remnant [1,5,12,14]. Postlaparoscopic bile duct injury is of important morbidity related partly to unrecognized anatomic variants of extrahepatic bile duct and cystic duct.…”

Hemobilia and cystic artery stump pseudoaneurysm associated with liver abscess after a laparoscopic cholecystectomy: Report of a case

“…Some authors have suggested that it may result from direct trauma to the vessel wall or a diathermy shorting of the surgical clip at the cystic artery stump. 2,12 Another author has suggested that it may result from a postoperative bile leak with subsequent infl ammation and erosion of the vessel wall. 9,11 We hypothesize that in our case, direct trauma of the vessel wall occurred during the dissection of the cystic artery at the infl amed Calot's triangle with subsequent PA formation.…”

“…Most cases of PA were embolized successfully using a transcatheter (84.6%), and some reports suggested that packing the hepatic artery PA sack with metal coils is an appropriate treatment. 11,12 However, a reruptured PA has also been reported after embolization requiring emergency surgical hepatic artery ligation or further embolization. 3,7,8,10 The recent surgical repair may be disrupted, and it is surgically diffi cult to gain a proximal and distal control of bleeding.…”

“…1 In this study, the site of PA, clinical presentation, treatment, and outcomes were reviewed based on 26 cases in the literature. [2][3][4][5][6][7][8][9][10][11][12] (Table 1). The intervals between a cholecystectomy and the onset of symptoms are variable; however, most such patients (80.7%) tend to be readmitted 4 weeks after initial LC, and the most common site of PA is the RHA (84.6%).…”

Therapeutic options for endoscopic haemostatic failures: the place of the surgeon and radiologist in gastrointestinal tract bleeding

“…38 Most of these bleeds occur after leakage of an anastomosis with secondary inflammation and pseudoaneurysm formation. [39][40][41] For haemodynamically stable patients upper GI endoscopy is the first diagnostic procedure to exclude the more common upper GI bleedings (see above).…”