CASE REPORT

Right hepatic artery pseudoaneurysm after choledocoduodenostomy: a case report

Erik Prabowo, Ahmad Fathi Fuadi , Antonius Gunawan Santoso

Erik Prabowo
Digestive Consultant Surgeon, Dr. Kariadi Hospital, Semarang, Indonesia

Ahmad Fathi Fuadi
Digestive Trainee Surgeon, Faculty of Medicine, Dr. Kariadi Hospital, Semarang, Indonesia. Email: fathi_doc@yahoo.co.id

Antonius Gunawan Santoso
Interventional Radiologist Consultant, Dr. Kariadi Hospital, Semarang, Indonesia
Online First: February 21, 2021 | Cite this Article
Prabowo, E., Fuadi, A., Santoso, A. 2021. Right hepatic artery pseudoaneurysm after choledocoduodenostomy: a case report. Bali Medical Journal 10(1): 35-37. DOI:10.15562/bmj.v10i1.2106


Background: Pseudoaneurysm of right hepatic artery is a rare complication after bile duct injury (BDI) repair. An unidentified rupture of pseudoanuerysm will lead to mismanagement of this fatal complication. Massive haemorrhage can present and causes high mortality

Case Description: We report a 60-year-old female who suffered jaundice and massive upper gastrointestinal bleeding two weeks after cholodocoduodenostomy bypass surgery in rural hospital. That procedure was done because of BDI after laparoscopic cholecystectomy. Embolisation was carried out after identifying an pseudoaneurysm of right hepatic artery to stop bleeding. Bleeding was transiently stopped, and rebleeding occurred several weeks later. Surgery was performed because of repeated bleeding after third embolization in Kariadi hospital. Ruptured pseudoaneurysm to choledocoduodenostomy anastomosis was found. Pseudoaneurysm was resected and right hepatic artery was sutured. Choledocoduodenostomy was closed. Continuity of biliary tract was maintained by re-reconstruction choledoco-jejunostomy roux n Y. Upper gastrointestinal bleeding symptom was disappeared, and bilirubin level was returned to normal at outpatient follow up after operation.

Conclusion: This patient had a hemobilia because of ruptured right hepatic artery pseudoaneurysm. Triad Quincke which consist of right upper quadrant pain, jaundice and upper gastrointestinal bleeding, occurs in 30% of patient with hemobilia. This sign of hemobilia after biliary tract procedure must be managed quickly and accurately. Angiography is main diagnostic procedure. Arterial embolisation is first line intervention to stop the bleeding. Surgery is preserved in case where rebleeding occurs. Good anatomical knowledge can prevent this complication.

References

Halasz NA. Cholecystectomy and Hepatic Artery Injuries. Arch Surg. 1991; 126: 137–138 https://doi.org/10.1001/archsurg.1991.01410260021002

Kassem TW. Right hepatic artery pseudoaneurysm as complication of laparoscopic cholecystectomy. Egypt J Radiol Nucl Med. 2017; 48: 931–933 https://doi.org/10.1016/j.ejrnm.2017.08.006

Tsai CH, Mo LR, Chiou CY, Ko QY, Hwang HS, Hwang MH, Yang CT, Liang TK. Therapeutic embolization of post-cholecystectomy hepatic artery aneurysm. Hepatogastroenterology. 1992; 39: 158–160

Berry R, Han J, Kardashian AA, LaRusso NF, Tabibian JH. Hemobilia: Etiology, diagnosis, and treatment. Liver Res. 2018; 2: 200–208 https://doi.org/10.1016/j.livres.2018.09.007

Senthilkumar MP, Battula N, Perera MTPR, Marudanayagam R, Isaac J, Muiesan P, Olliff SP, Mirza DF. Management of pseudo-aneurysm in the hepatic artery after laparoscopic cholecystectomy. Ann R Coll Surg Engl. 2016; 98: 456–460 https://doi.org/10.1308/rcsann.2016.0182

Strasberg SM, Helton WS. An analytical review of vasculobiliary injury in laparoscopic and open cholecystectomy. Hpb. 2011; 13: 1–14 https://doi.org/10.1111/j.1477-2574.2010.00225.x

Cheung HYS, Tang CN. Bleeding pseudoaneurysms complicating upper abdominal surgery. Hong Kong Med J. 2007; 13: 449–452

Regalado S, Funaki B. Radiological reasoning: Postoperative hemorrhage after open cholecystectomy and common bile duct exploration. Am J Roentgenol. 2008; 190: 69–74 https://doi.org/10.2214/ajr.07.7006

Milburn JA, Hussey JK, Bachoo P, Gunn IG. Right Hepatic Artery Pseudoaneurysm Thirteen Months Following Laparoscopic Cholecystectomy. EJVES Extra. 2007; 13: 1–3 https://doi.org/10.1016/j.ejvsextra.2006.09.005


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