Iatrogenic Cystic Artery Pseudoaneurysm Post Laparoscopic Cholecystectomy: Original Case Report with Literature Review
Po Hong Tan, Elyaraitul Nadia Rahim, Kah Chun Yong, Norhafizah Ehsan, Kharlina Khairudin
Keywords :
Aneurysm, Case report, Cholecystectomy, False, Hemobilia, Laparoscopic
Citation Information :
Tan PH, Rahim EN, Yong KC, Ehsan N, Khairudin K. Iatrogenic Cystic Artery Pseudoaneurysm Post Laparoscopic Cholecystectomy: Original Case Report with Literature Review. World J Lap Surg 2023; 16 (2):90-93.
Cystic artery pseudoaneurysm post laparoscopic cholecystectomy is a rare complication associated with potential risk of morbidity and mortality. This is a case of cystic artery pseudoaneurysm post laparoscopic cholecystectomy in a 27-year-old female who presented postop. day 10 post laparoscopic cholecystectomy with abdominal pain, melena, and hematemesis. Esophagogastroduodenoscopy showed no active bleeder, and initial computed tomography (CT) only showed gallbladder bed hematoma that was treated in percutaneous drainage. However, recurrent symptoms prompt a CT angiography that revealed a cystic artery pseudoaneurysm with hemoperitoneum. The pseudoaneurysm was successfully treated with transarterial catheter embolization of the cystic artery stump. She was well post intervention but required parenteral antibiotics resulting in a 2-week hospitalization, and eventually discharged.
Literature review reports only 10 cases of iatrogenic cystic artery pseudoaneurysm post laparoscopic cholecystectomy in the last two decades. Based on our literature review, the main presentation is usually hemobilia (70%), age of the patient ranging 26–79 years old, and timing of presentation ranging from 1 week to 3 years post laparoscopic cholecystectomy. The pathophysiology is often due to indirect or direct thermal injury during cauterization. Computed tomography angiography is the investigation of choice. Transarterial embolization is the treatment of choice with high success rate. However, surgery still plays a role in complex cases where embolization failed. There should be a high index of suspicion of such pathology, especially in patients who present with upper gastrointestinal bleed post cholecystectomy, so early diagnosis and treatment can be done.
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