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Hsiung T, Lee TS, Lee YL, Huang TS, Wang CY. Recurrent right hepatic artery pseudoaneurysm after robotic-assisted cholecystectomy in a patient with Mirizzi syndrome: a case report. BMC Surg 2022; 22:112. [PMID: 35321717 PMCID: PMC8943984 DOI: 10.1186/s12893-021-01438-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 12/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background Iatrogenic hepatic artery pseudoaneurysm is a rare complication following laparoscopic cholecystectomy. Trans-arterial embolization (TAE) is an effective way to control bleeding after a ruptured aneurysm. But uncommonly, rebleeding may occur which will require a second embolization or even laparotomy. Case presentation We report a case of a 45-year-old woman who underwent robotic-assisted cholecystectomy after the diagnosis of type II Mirizzi syndrome. During the operation, the anterior branch of the right hepatic artery was damaged and Hem-o-lok clips were applied to control the bleeding. The postoperative course was smooth, and the patient was discharged 6 days after the procedure. However, one week after hospital discharge, she presented to the emergency department with right upper abdominal tenderness, melena, and jaundice. After examination, the computed tomography angiography (CTA) revealed a 3 cm pseudoaneurysm at the distal stump of the right hepatic artery anterior branch. TAE with gelfoam material was performed. Three days later, the patient had an acute onset of abdominal pain. A recurrent pseudoaneurysm was found at the same location. She underwent TAE again but this time with a steel coil. No further complication was noted, and she was discharged one week later. Conclusions Even with the assistance of modern technologies such as the robotic surgery system, one should still take extra caution while handling the vessels. Also, embolization of the pseudoaneurysm with steel coils may be suitable for preventing recurrence.
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Affiliation(s)
- Ted Hsiung
- Department of General Surgery, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Tsung-Shih Lee
- Division of Hepato-gastroenterology, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Yueh-Lin Lee
- Department of Radiology, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Ting-Shuo Huang
- Department of General Surgery, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Chih-Yuan Wang
- Department of General Surgery, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan.
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Lampropoulos C, Markopoulos G, Tsochatzis S, Bellou A, Amanatidis T, Kehagias D, Papadopoulos G, Kehagias I. Symptomatic pseudoaneurysms following laparoscopic cholecystectomy: Focus on an unusual and dangerous complication. J Minim Access Surg 2021; 17:450-457. [PMID: 34558424 PMCID: PMC8486062 DOI: 10.4103/jmas.jmas_164_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/03/2020] [Accepted: 09/20/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) has been associated with an increase in the incidence of biliary and vascular injuries. Pseudoaneurysms (PAs) following LC are rare life-threatening events with limited available experience regarding diagnosis and treatment. MATERIALS AND METHODS An extensive review of literature during a 26-year period (1994-2020) using MEDLINE® database and Google Scholar® academic search engine revealed 134 patients with at least one symptomatic PA following LC. RESULTS Nearly. 81% of patients with PAs become symptomatic during the first 8 weeks following LC. The most common symptoms were gastrointestinal bleeding (74%) and abdominal pain (61%). In 28% of cases, there was a concomitant bile duct injury or leak from the cystic duct stump, whereas in about one-third of cases, PAs presented following an uneventful LC. The most common involved arteries were the right hepatic artery (70%), the cystic artery (19%) or both of them (3%). Trans-arterial embolisation was the favoured first-line treatment with a success rate of 83%. During a median follow-up of 9 months, the mortality rate was 7%. CONCLUSION Clinicians should be aware of the PA occurrence following LC. Prompt diagnosis and treatment are essential.
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Affiliation(s)
| | | | | | - Aggeliki Bellou
- Department of Pulmonary Medicine, General University Hospital of Patras, Patras, Greece
| | | | - Dimitrios Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | | | - Ioannis Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
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Gandhi RJ, Gala KB, Gandhi AK. Role of Transarterial Embolization in the Management of Hepatic Artery Pseudoaneurysm Postlaparoscopic Cholecystectomy. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2020. [DOI: 10.1055/s-0040-1721533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Abstract
Purpose To assess the safety and effectiveness of transarterial embolization (TAE) in the management of hepatic artery pseudoaneurysms following laparoscopic cholecystectomy (LC).
Materials and Methods This is a retrospective study consisting of 13 patients who had undergone TAE for management of pseudoaneurysms of the hepatic artery or its branches following LC. Patients presented with symptoms such as hypotension, hematemesis, melena or gradual anemia post LC. Abdominal CT revealed hepatic artery pseudoaneurysm in all patients. TAE was performed with either coils or N-butyl cyanoacrylate or both. We evaluated technical and clinical effectiveness and complications of TAE.
Results TAE was successful both technically and in stopping bleeding in all patients (100% technical and clinical success). No patient had rebleeding after TAE. Four patients required laparotomy for draining hemoperitoneum and clots. Endoscopic retrograde cholangiopancreatography (ERCP) for hemobilia or bile duct injury was done in eight patients. Following TAE, hepatic infarct was observed in three patients. Postembolization syndrome was seen in four patients and one patient died due to sepsis.
Conclusions TAE is effective for treatment of hepatic artery pseudoaneurysms after LC. Hepatic infarcts and postembolization syndrome are the most common complications and can be managed conservatively.
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Affiliation(s)
- Rozil Jayesh Gandhi
- Department of Radiodiagnosis, Shardaben Municipality Hospital, Ahmedabad, Gujarat, India
| | - Kunal Bharat Gala
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai, India
| | - Aditi K. Gandhi
- Department of Radiodiagnosis, Shardaben Municipality Hospital, Ahmedabad, Gujarat, India
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Machado NO, Al-Zadjali A, Kakaria AK, Younus S, Rahim MA, Al-Sukaiti R. Hepatic or Cystic Artery Pseudoaneurysms Following a Laparoscopic Cholecystectomy: Literature review of aetiopathogenesis, presentation, diagnosis and management. Sultan Qaboos Univ Med J 2017; 17:e135-e146. [PMID: 28690884 DOI: 10.18295/squmj.2016.17.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/22/2016] [Accepted: 10/22/2016] [Indexed: 01/28/2023] Open
Abstract
Pseudoaneurysms (PSAs) of the hepatic and/or cystic artery are a rare complication following a laparoscopic cholecystectomy (LC). Generally, PSA cases present with haemobilia several weeks following the procedure. Transarterial embolisation (TAE) is considered the optimal management approach. We report a 70-year-old woman who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in 2016 with massive hemoperitoneum two weeks after undergoing a LC procedure in another hospital. She was successfully managed using coil TAE. An extensive literature review revealed 101 cases of hepatic or cystic artery PSAs following a LC procedure. Haemobilia was the main presentation (85.1%) and the mean time of postoperative presentation was 36 days. The hepatic artery was involved in most cases (88.1%), followed by the cystic artery (7.9%) and a combination of both (4.0%). Most cases were managed with TAE (72.3%), with a 94.5% success rate. The overall mortality rate was 2.0%.
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Affiliation(s)
- Norman O Machado
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Adil Al-Zadjali
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Anupam K Kakaria
- Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shahzad Younus
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mohamed A Rahim
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Rashid Al-Sukaiti
- Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
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5
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Compressive hematoma due to pseudoaneurysm of the right hepatic artery: a rare cause of obstructive jaundice after single-port cholecystectomy. Surg Laparosc Endosc Percutan Tech 2015; 25:e42-e44. [PMID: 24743679 DOI: 10.1097/sle.0000000000000024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Single-port laparoscopic cholecystectomy is considered as a form of natural orifice surgery with better esthetic outcomes than traditional laparoscopic cholecystectomy. It is a technically demanding procedure, and no adequately powered trial has assessed the safety of this technique. Vascular injuries are less common than bile duct injuries during this procedure, but they can be rapidly fatal. The development of a right hepatic artery pseudoaneurysm is a rare but serious complication associated with single-port laparoscopic cholecystectomy. Two weeks following a single-port laparoscopic cholecystectomy for angiocholitis, a 40-year-old male patient presented with obstructive jaundice and persistent abdominal pain. The diagnosis of compressive hematoma due to a ruptured right hepatic artery pseudoaneurysm was confirmed by computed tomography scan and angiography. It was successfully treated by selective embolization of the right hepatic artery. In our experience, endovascular management was a noninvasive and effective treatment of ruptured pseudoaneurysms.
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6
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Tétreau R, Beji H, Henry L, Valette PJ, Pilleul F. Arterial splanchnic aneurysms: Presentation, treatment and outcome in 112 patients. Diagn Interv Imaging 2015; 97:81-90. [PMID: 26292616 DOI: 10.1016/j.diii.2015.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 06/08/2015] [Accepted: 06/30/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to identify subgroups with different risks of progression and their appropriate management among the heterogeneous group of 112 patients diagnosed with splanchnic aneurysm. METHODS Using radiology databases and medical records of our institution (Hospital Édouard-Hérriot, Lyon, France), we undertook a retrospective review of all patients diagnosed with splanchnic artery aneurysms from 1995 to 2011. Cases were analyzed by aneurysm location, etiology and a distinction was also made between true and false aneurysms. RESULTS False aneurysms were more likely than true aneurysms to be diagnosed as symptomatic and/or ruptured (TA: 50/66 patients asymptomatic vs. FA: 16/46 asymptomatic, P<0.05) with a rupture rate of 59% (27/46) which was unrelated to the size of aneurysms. Percutaneous treatment was carried in the majority of patients with a final success rate of 91%. Peripancreatic true aneurysms were associated in 75% of cases with celiac occlusive disease and diagnosed mostly in symptomatic patients (7/9: 78%) with a rupture rate of 44% unrelated to their size. Radiologic treatment has faced problems due to failure of catheterization and incomplete embolization, although there have been cases in which delayed occlusion was achieved. Common true aneurysms were incidental findings in 87% (57/66) of patients with 3 ruptured aneurysms which were larger than 2 cm. Observation in that group was safe: significant growth was seen only in one patient and the embolization required was successful. Splanchnic false aneurysms and peripancreatic true aneurysms carried a high and an unpredictable risk of rupture that warranted prompt endovascular treatment as soon as possible. CONCLUSIONS Stratification by localization and by the true or false appearance of the aneurysm was an effective (means of identifying) way to identify subgroups with different risks of progression. False aneurysms and peripancreatic true aneurysms carried a high and unpredictable risk of rupture. The splanchnic aneurysms should have been treated in the case of patients of childbearing age, size ≥ 20 mm, and in the case of liver transplantation. Other splanchnic aneurysms should either have been observed, if smaller than 2 cm. In the absence of rigorous published comparisons, surgical and endovascular methods should have been considered equally suitable in the elective treatment of these patients.
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Affiliation(s)
- R Tétreau
- Centre d'Imagerie Médicale, Institut du Cancer, 3, rue Croix-Verte, 34000 Montpellier, France
| | - H Beji
- Radiologie, CLCC Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - L Henry
- Radiologie, Hôpital Édouard-Hérriot, 69003 Lyon, France
| | - P-J Valette
- Radiologie, Hôpital Édouard-Hérriot, 69003 Lyon, France
| | - F Pilleul
- Centre d'Imagerie, CLCC Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
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7
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Severe hemobilia from hepatic artery pseudoaneurysm. Case Rep Gastrointest Med 2011; 2011:925142. [PMID: 22606431 PMCID: PMC3350305 DOI: 10.1155/2011/925142] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Accepted: 07/06/2011] [Indexed: 11/29/2022] Open
Abstract
Background. Hemobilia is a rare, jeopardizing complication of laparoscopic cholecystectomy coming upon usually within 4 weeks after surgery. The first-line management is angiographic coil embolization of hepatic arteries, which is successful in the majority of bleedings: in a minority of cases, a second embolization or even laparotomy is needed. Case Presentation. We describe the case history of a patient in which laparoscopic cholecystectomy was complicated 3 weeks later by massive hemobilia. The cause of haemorrhage was a pseudoaneurysm of a right hepatic artery branching off the superior mesenteric artery; this complication was successfully managed by one-stage angiographic embolization with full recovery of the patient.
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Strasberg SM, Helton WS. An analytical review of vasculobiliary injury in laparoscopic and open cholecystectomy. HPB (Oxford) 2011; 13:1-14. [PMID: 21159098 PMCID: PMC3019536 DOI: 10.1111/j.1477-2574.2010.00225.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 07/22/2010] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Biliary injuries are frequently accompanied by vascular injuries, which may worsen the bile duct injury and cause liver ischemia. We performed an analytical review with the aim of defining vasculobiliary injury and setting out the important issues in this area. METHODS A literature search of relevant terms was performed using OvidSP. Bibliographies of papers were also searched to obtain older literature. RESULTS Vasculobiliary injury was defined as: an injury to both a bile duct and a hepatic artery and/or portal vein; the bile duct injury may be caused by operative trauma, be ischaemic in origin or both, and may or may not be accompanied by various degrees of hepatic ischaemia. Right hepatic artery (RHA) vasculobiliary injury (VBI) is the most common variant. Injury to the RHA likely extends the biliary injury to a higher level than the gross observed mechanical injury. VBI results in slow hepatic infarction in about 10% of patients. Repair of the artery is rarely possible and the overall benefit unclear. Injuries involving the portal vein or common or proper hepatic arteries are much less common, but have more serious effects including rapid infarction of the liver. CONCLUSIONS Routine arteriography is recommended in patients with a biliary injury if early repair is contemplated. Consideration should be given to delaying repair of a biliary injury in patients with occlusion of the RHA. Patients with injuries to the portal vein or proper or common hepatic should be emergently referred to tertiary care centers.
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Affiliation(s)
- Steven M Strasberg
- Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Washington University in Saint Louis, St Louis, MO 63110, USA.
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9
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Wani NA, Gojwari TA, Khan NA, Kosar TL. Hemobilia in a child due to right hepatic artery pseudoaneurysm: multidetector-row computed tomography demonstration. Saudi J Gastroenterol 2011; 17:152-4. [PMID: 21372357 PMCID: PMC3099065 DOI: 10.4103/1319-3767.77250] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of a 12-year-old boy who developed upper gastrointestinal bleeding in the form of hematemesis and melena 1 month after blunt trauma to liver. Computed tomography (CT) angiography with multidetector-row CT demonstrated pseudoaneurysm of right hepatic artery related to old liver laceration to be the cause of the bleeding. Pseudoaneurysm was resected using the roadmap provided by CT angiography findings.
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Affiliation(s)
- Nisar A. Wani
- Department of Radiodiagnosis and Imaging, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, J & K, India,Address for correspondence: Dr. Nisar A. Wani, Department of Radiodiagnosis and Imaging, Sher-I-Kashmir Institute of Medical Sciences, Srinagar - 190 011, India. E-mail:
| | - Tariq A. Gojwari
- Department of Radiodiagnosis and Imaging, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, J & K, India
| | - Naseer A. Khan
- Department of Radiodiagnosis and Imaging, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, J & K, India
| | - Tasleem L. Kosar
- Department of Radiodiagnosis and Imaging, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, J & K, India
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10
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Strasberg SM, Helton WS. An analytical review of vasculobiliary injury in laparoscopic and open cholecystectomy. HPB (Oxford) 2010. [PMID: 21159098 DOI: 10.1111/j.1477-2574.2010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
OBJECTIVES Biliary injuries are frequently accompanied by vascular injuries, which may worsen the bile duct injury and cause liver ischemia. We performed an analytical review with the aim of defining vasculobiliary injury and setting out the important issues in this area. METHODS A literature search of relevant terms was performed using OvidSP. Bibliographies of papers were also searched to obtain older literature. RESULTS Vasculobiliary injury was defined as: an injury to both a bile duct and a hepatic artery and/or portal vein; the bile duct injury may be caused by operative trauma, be ischaemic in origin or both, and may or may not be accompanied by various degrees of hepatic ischaemia. Right hepatic artery (RHA) vasculobiliary injury (VBI) is the most common variant. Injury to the RHA likely extends the biliary injury to a higher level than the gross observed mechanical injury. VBI results in slow hepatic infarction in about 10% of patients. Repair of the artery is rarely possible and the overall benefit unclear. Injuries involving the portal vein or common or proper hepatic arteries are much less common, but have more serious effects including rapid infarction of the liver. CONCLUSIONS Routine arteriography is recommended in patients with a biliary injury if early repair is contemplated. Consideration should be given to delaying repair of a biliary injury in patients with occlusion of the RHA. Patients with injuries to the portal vein or proper or common hepatic should be emergently referred to tertiary care centers.
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Affiliation(s)
- Steven M Strasberg
- Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Washington University in Saint Louis, St Louis, MO 63110, USA.
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11
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Slaba S, Abed O, Mallak N, Nassar J. [Transhepatic embolization of a hepatic artery aneurysm following laparoscopic cholecystectomy]. JOURNAL DES MALADIES VASCULAIRES 2010; 35:355-358. [PMID: 20580174 DOI: 10.1016/j.jmv.2010.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Accepted: 04/28/2010] [Indexed: 05/29/2023]
Abstract
Vascular complications following laparoscopic cholecystectomy are less frequent but carry higher morbidity than bile ducts lesions. We report on a 19-year-old patient, who presented a ruptured pseudoaneurysm of the hepatic artery 2 months after laparoscopic cholecystectomy. This case illustrates the alternative of direct transhepatic puncture with exclusive glue embolization in case of endovascular access failure.
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Affiliation(s)
- S Slaba
- Service d'imagerie médicale, Hôtel-Dieu de France, boulevard Alfred-Nacchache, Achrafieh, BP 16, 6830 Beyrouth, Liban
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12
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Postlaparoscopic iatrogenic pseudoaneurysms of the arteries of the peritoneal and retroperitoneal space: case report and review of the literature. Surg Laparosc Endosc Percutan Tech 2010; 19:90-7. [PMID: 19390271 DOI: 10.1097/sle.0b013e31819ca96b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Laparoscopic surgery procedures are associated with a low percentage of cases of iatrogenic traumatic laceration of the arteries of the peritoneal and retroperitoneal space. These lesions rarely lead to pseudoaneurysm formation. In 1 case, we performed a meta-analytic review of the literature on postlaparoscopic iatrogenic pseudoaneurysms focusing on specific parameters: (1) artery involved, (2) type of laparoscopic operation, (3) time interval between the laparoscopic operation and the final diagnosis of the pseudoaneurysm, (4) clinical presentation, (5) diagnostic tools used, (6) mode of treatment applied, and (7) clinical outcome. MATERIALS AND METHODS We searched Medline for pseudoaneurysms developing as complications of laparoscopic procedures. The search terms used were "iatrogenic pseudoaneurysm," "complications after laparoscopic procedures," "traumatic arterial laceration," "pseudoaneurysm formation," and "postoperative hematoma" in various combinations. RESULTS AND CONCLUSIONS A total of 66 cases were retrieved. Postlaparoscopic iatrogenic pseudoaneurysms are late manifestations of arterial complications developing during routine laparoscopy. There are 66 reported cases of this type of complication in the literature. The majority occurs in the arteries of the operation field of the respective laparoscopic procedure. Distal vessels are involved less frequently. They usually present after a mean period of approximately 6 weeks. The hepatic and renal arteries are usually affected. The clinical picture includes upper and lower gastrointestinal bleeding, diffuse or localized abdominal pain, hematuria, and drain bleeding.
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13
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Petroianu A. Arterial embolization for hemorrhage caused by hepatic arterial injury. Dig Dis Sci 2007; 52:2478-81. [PMID: 17410453 DOI: 10.1007/s10620-006-9704-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2006] [Accepted: 11/26/2006] [Indexed: 12/30/2022]
Abstract
Fewer than 10% of patients with major liver trauma have life-threatening bleeding. Laparoscopic operations, endoscopic procedures, and percutaneous interventions such as drainages, vascular or tumor sclerosis, biopsies, and transjugular intrahepatic portocaval shunt (TIPS) have increased the number of iatrogenic vascular and bile duct injuries. Due to its therapeutic success, arterial embolization (AE) has become the standard treatment for late complications of hepatic injury. In some cases, this procedure may be used as the first approach on accidental or iatrogenic arterial trauma and in several hepatic arterial diseases. The result of this method depends on physician experience, size of the wound, and stability of the patient. Persistent hemorrhage and rebleeding may be treated with a new AE or an operation. Precise indication and a correctly performed AE are key factors for a successful treatment. Rebleeding episodes are a rare occurrence, which may be treated with AE as well.
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Affiliation(s)
- A Petroianu
- Department of Surgery, Medical School, Federal University of Minas Gerais, AvenidaAlfredo Balena 190, Belo Horizonte, MG, 30130-100, Brazil.
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14
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Tétreau R, Monneuse O, Allaouchiche B, Pilleul F. [Post-traumatic hepatic artery pseudoaneurysm: percutaneous embolization with glue]. JOURNAL DE RADIOLOGIE 2007; 88:975-7. [PMID: 17878856 DOI: 10.1016/s0221-0363(07)89906-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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15
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Moukaddam H, Al-Kutoubi A. Pseudoaneurysms of Hepatic Artery Branches: Treatment with Self-expanding Stent-grafts in Two Cases. J Vasc Interv Radiol 2007; 18:897-901. [PMID: 17609450 DOI: 10.1016/j.jvir.2007.04.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Pseudoaneurysms of the hepatic artery or its branches are rare complications with several potential causes. Herein, the authors report two cases of pseudoaneurysms of hepatic artery branches, one secondary to laparoscopic surgery and the other probably due to malignancy. The pseudoaneurysms were treated with the placement of self-expanding stent-grafts. Complete and prompt occlusion of the pseudoaneurysm was achieved in both patients, with resolution of symptoms and preservation of the blood flow in the parent arterial branch at long-term follow-up.
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Affiliation(s)
- Hicham Moukaddam
- Department of Diagnostic Radiology, the American University of Beirut Medical Center, Beirut, Lebanon
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16
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Masannat YA, Al-Naser S, Al-Tal Y, Al-Koteesh J, Sharaf UI. A rare complication of a common operation: hepatic artery pseudo aneurysm following cholecystectomy report of a case. Ir J Med Sci 2007; 177:397-8. [PMID: 17588193 DOI: 10.1007/s11845-007-0053-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2006] [Accepted: 05/09/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Vascular injuries following cholecystectomy are a known entity though the incidence is low. More frequently we are seeing cases of right hepatic artery pseudo aneurysm post cholecystectomy after the advent of the laparoscopic approach. METHODS We report a case of multiple right hepatic artery aneurysms as a complication of cholecystectomy in a 71-year-old patient. RESULTS The diagnosis was confirmed by angiogram, and the patient was treated successfully with coil embolisation. CONCLUSION Though it is a rare complication, early diagnosis and treatment of postoperative pseudo aneurysm is essential to prevent life threatening bleeding.
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Affiliation(s)
- Y A Masannat
- Breast Unit/General Surgical Department, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK.
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17
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Marcheix B, Dambrin C, Cron C, Sledzianowski JF, Aguirre J, Suc B, Cerene A, Rousseau H. Embolisation transhépatique percutanée d’un pseudoanévrisme post-traumatique de l’artère hépatique. ACTA ACUST UNITED AC 2004; 129:603-6. [PMID: 15581823 DOI: 10.1016/j.anchir.2004.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pseudoaneurysm of the hepatic artery is a rare complication of blunt abdominal trauma. We report a case of post-traumatic pseudoaneurysm diagnosed several months after the initial traumatism in a 18-year-old man who presented recurrent abdominal pain. This pseudoaneurysm was successfully treated by association of both classical endovascular treatment and transhepatic percutaneous embolization.
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Affiliation(s)
- B Marcheix
- Service de chirurgie cardiovasculaire, CHU Rangueil, 1, avenue Jean-Poulhes, 31403 Toulouse, cedex, France
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