Visceral Artery Pseudoaneurysms Following Pancreatoduodenectomy

Otah, Eseroghene; Cushin, Brian; Rozenblit, Grigory; Neff, Richard; Otah, Kenneth E.; Cooperman, Avram M.

doi:10.1001/archsurg.137.1.55

Cited by 135 publications

(116 citation statements)

References 19 publications

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“…[7][8][9] The mechanism of hepatic or cystic artery pseudoaneurysms post cholecystectomy is unclear but likely involves direct vascular injury, thermal injury, erosion due to clip intrusion, bile leakage, and infection. 10 The cytotoxic properties of high concentrations of intracellular or extracellular bile have been postulated to cause direct weakening of the suture line and to erode the vascular wall, leading to pseudoaneurysm formation. 11 Secondary infection propagated by the presence of a biloma has been discussed as a precipitant to pseudoaneurysm formation.…”

Section: Discussionmentioning

confidence: 99%

Hemobilia Due to Cystic Artery Stump Pseudoaneurysm Following Laparoscopic Cholecystectomy: Case Presentation and Literature Review

Petrou

Brennan

Soonawalla

et al. 2012

International Surgery

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Hemobilia is the process of bleeding into the biliary tree and is an unusual cause of upper gastrointestinal hemorrhage. When this event results from a cystic artery pseudoaneurysm, it is a particularly rare phenomenon; fewer than 20 cases are described in the literature. Alongside the literature review, we report a case of a 34-year-old woman presenting 3 months post laparoscopic cholecystectomy with hematemesis. Computed tomography (CT) angiography revealed a cystic artery pseudoaneurysm. Following an ineffective hyperselective arterial embolization, the patient was successfully treated by surgical ligation of the right hepatic artery. Even though this complication is uncommon, all surgeons need to be aware of its presentation and of available therapeutic options.Key words: Hemobilia -Cystic artery -Pseudoaneurysm U pper gastrointestinal bleeding originating from the biliary tree (hemobilia) is an uncommon but well-described condition. Hepatic trauma and iatrogenic injury are the principal causative factors. 1Cystic artery pseudoaneurysm as the cause of hemobilia represents a rare phenomenon. The most frequent causes are acute cholecystitis and cholecystectomy-related injury. Here we present a case from our center and a review of the literature on hemobilia in association with a cystic artery pseudoaneurysm. Case PresentationA 34-year-old woman presented to the emergency department 3 months post laparoscopic cholecystectomy with epigastric pain, nausea, and multiple episodes of hematemesis. With the exception of recent laparoscopic cholecystectomy, the patient had no significant past medical history. On examination, she was pale; blood pressure was 105/60 mmHg and heart rate was 98 bpm. Epigastric and right upper quadrant tenderness was noted. Laboratory

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Section: Discussionmentioning

confidence: 99%

Hemobilia Due to Cystic Artery Stump Pseudoaneurysm Following Laparoscopic Cholecystectomy: Case Presentation and Literature Review

Petrou

Brennan

Soonawalla

et al. 2012

International Surgery

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“…SA may also show active bleeding and anatomic variations such as anomalous or replaced hepatic arteries (16). Thus, some authors recommend an initial CT scan if HAPA is suspected, followed by a confirmatory SA (17).…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal hemorrhage caused by rupture of a pseudoaneurysm of the hepatic artery

Doğan

Yıldırım²,

Göktürk³

2012

Turk J Gastroenterol

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“…These results were consistent with the reports in literature. [21][22][23] Our data suggest that if the patient is hemodynamically stable, it is of worth to repeat angiogram. Also majority of patients with negative angiogram can be managed with conservative means.…”

Section: -15mentioning

confidence: 88%

Post pancreatic surgery hemorrhage: management and outcome

Sharma

2016

Int Surg J

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Background: Postoperative hemorrhage after pancreatic surgery is a serious complication. This study analyzed clinical presentation, risk factors and management of post pancreatic surgery hemorrhage to determine the role of angioembolization and surgery. Methods: 536 patients who underwent pancreatic surgery from 2003 to 2009 were studied with regard to postoperative hemorrhage. The severity of bleeding (mild, moderate and severe) and presentation (early, delayed) was defined as per guidelines of international study group of pancreatic surgery definition. Associated postoperative complications, diagnostic workup, interventions done and their outcomes were analyzed. Results: 24 out of 536 (4.47%) had post pancreatic surgery hemorrhage. 17 were male and 7 were female. Mean age of the patients was 48.87 (Range 17-78 years). Of these 24 patients 13 (54.16%) had underwent Whipple's procedure, 9 (37.5%), Frey's operation, 1 (4.16 %) enucleation of insulinoma and 1 (4.16%) median pancreatectomy. 4 patients presented as early hemorrhage, delayed presentation was in 20 patients. Extraluminal hemorrhage was present in 8 patients, 13 patients manifested as intraluminal hemorrhage whereas combined extra and intraluminal hemorrhage was present in 3 cases. Conservative management was done in 7 patients, 13 patients required angiography and surgical management was done in 8 patients. There were 4 deaths; rest 20 patients were managed successfully. Conclusions: Hemorrhage after pancreatic surgery occurred in 4.47% of cases. Early hemorrhage is usually due to failure of primary hemostasis. Postoperative pancreatic fistula is the main risk factor for delayed postoperative hemorrhage. Angiographic embolization was the procedure of choice for controlling delayed bleeding. Both surgery and angiography had role in post pancreatectomy hemorrhage.

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Visceral Artery Pseudoaneurysms Following Pancreatoduodenectomy

Cited by 135 publications

References 19 publications

Hemobilia Due to Cystic Artery Stump Pseudoaneurysm Following Laparoscopic Cholecystectomy: Case Presentation and Literature Review

Hemobilia Due to Cystic Artery Stump Pseudoaneurysm Following Laparoscopic Cholecystectomy: Case Presentation and Literature Review

Gastrointestinal hemorrhage caused by rupture of a pseudoaneurysm of the hepatic artery

Post pancreatic surgery hemorrhage: management and outcome

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