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Pseudoaneurysm of the Hepatic Artery Presenting with Hemobilia – a Complication of Laparoscopic Cholecystectomy


Authors: K. Schwarzmannová 1;  T. Poch 1;  J. Šimša 1;  T. Vidim 1;  P. Chudomel 1;  P. Volšanský 2;  S. Kašík 3;  M. Chochola 4
Authors‘ workplace: Chirurgické oddělení Oblastní nemocnice Kolín, a. s., primář: doc. MUDr. J. Šimša, Ph. D. 1;  Endoskopické centrum Oblastní nemocnice Kolín, a. s., primář: MUDr. P. Volšanský 2;  Radiodiagnostické oddělení Oblastní nemocnice Kolín, a. s., primář: MUDr. S. Kašík 3;  Angiocentrum Kolín, a. s., vedoucí lékař: MUDr. P. Kudrna 4
Published in: Rozhl. Chir., 2008, roč. 87, č. 7, s. 360-363.
Category: Monothematic special - Original

Overview

Introduction:
Hemobilia, defined as a bleeding into the bile duct, is a rare disease. One of its infrequent causes is a hepatic artery pseudoaneurysm, usually developed after arterial iatrogenic leasion.

Material and methods:
A case review, presenting right hepatic artery pseudoaneurysm with a biliovascular fistula as a consequence of hepatic artery and bile duct injuries during „uncomplicated“ laparoscopic cholecystectomy.

Discussion:
Bile duct injury is one of the most serious complication after laparoscopic cholecystectomy. Hepatic artery may be injured simultaneously, resulting in the pseudoaneurysm and/or biliovascular fistula, presenting with hemobilia. Time interval from the injury to symptoms widely varies from few hours to weeks or even several months.

Conclusion:
Melena or hematemesis after recent laparoscopic cholecystectomy should be always suspicious from hepatic artery and/or bile duct injuries, manifesting with hemobilia.

Key words:
laparoscopic cholecystectomy – complication – pseudoaneurysm – biliovascular fistula – hemobilia – embolisation – stent


Sources

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3. Šiller, J., Havlíček, K., Turnovský, P., et al. Hemobilie, vzácná příčina krvácení do GIT. Rozhl. Chir., 2008, 87(2): 89–91.

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7. Srinivasaiah, N., Bhojak, M., Jackson, R., et al. Vascular emergencies in cholelithiasis and cholecystectomy: our experiences with two cases and literature review. Hepatobiliary Pancreat. Dis. Int., 2008, 7(2): 217–220.

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