Post-cholecystectomy vascular and biliary injury resulting in hepatic artery pseudoaneurysm presenting with hemobilia and bile leak- a rare complication and surgical management

Abstract

Iatrogenic injuries to common bile duct (CBD) and hepatic artery system may occur separately or simultaneously. Although rare, vascular injuries may lead to pseudoaneurysm formation. These are serious complications and are difficult to detect. Review of the literature reveals fifty-four more cases of cholecystectomy related pseudoaneurysms. The site of injury was the right hepatic artery (RHA) in 61% of the cases. And two-thirds of these patients presented with hemobilia. In management of such cases, angiographic embolization is the first line of treatment, while surgery is reserved for more complex injuries and cases with life-threatening rupture of the aneurysm. Out of those presenting with hemobilia, 82% were treated with embolization and surgical management was required in the remaining 18%. Knowledge of the condition should result in early diagnosis and thus limit the resultant morbidity. We present a case of Post-cholecystectomy hemobilia and bile leak resulting from pseudoaneurysm following hepatic artery and bile duct injury, requiring surgical correction.