Hepatic artery pseudoaneurysm and hemobilia following laser laparoscopic cholecystectomy. A case report.
This report describes injury to the hepatic artery with pseudoaneurysm formation and hemobilia following the use of laser-assisted dissection to perform laparoscopic cholecystectomy. A 57-year-old woman was referred emergently 2 weeks after laser laparoscopic cholecystectomy with upper abdominal pain, upper gastrointestinal bleeding, and jaundice. A selective hepatic arteriogram showed a right hepatic artery pseudoaneurysm which was embolized. Two weeks later the patient had recurrent hemobilia as the result of blood flow restoration in the pseudoaneurysm and a fistula to the cystic duct remnant. She was treated with two additional embolizations and direct injection of the aneurysm with thrombogenic material. Follow-up at 2 years showed no further recurrence. Since the laser has never been shown to have advantages over electrocautery, its use during laparoscopic cholecystectomy is difficult to justify.
Genyk
Y S
YS
Department of Surgery, University of Alabama, Birmingham Medical Center, University Station 35294.
Keller
F S
FS
Halpern
N B
NB
D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006431:Hemobilia / Q000000981:diagnostic imaging / Q000209:etiology*; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects*; D008875:Middle Aged; D011859:Radiography