Vascular emergencies in cholelithiasis and cholecystectomy: our experience with two cases and literature review.
BACKGROUND
Complications from gallstones and laparoscopic cholecystectomy can be serious and fatal if there is a delay in recognition and treatment. We aim to present two unusual, life threatening vascular complications as a result of gallstones and laparoscopic cholecystectomy. Their management is highlighted with a brief review of literature.


METHODS
Data for the article were gathered from clinical case note review. Radiology database was used for images. A brief literature review was undertaken using Pubmed search. The keywords used included hemobilia, pseudoaneurysm, arterio-biliary fistula and laparoscopic cholecystectomy.


RESULTS
The article highlights two individual case reports. The first case constitutes an 81-year woman who had cystic arterial erosion causing hematemesis, while the second patient was a 57-year man who presented with hemobilia from a pseudoaneurysm of right hepatic artery (RHA) following laparoscopic cholecystectomy. Cystic arterial erosion was treated with subtotal cholecystectomy with duodenal defect closure while the pseudoaneurysm underwent radiological intervention.


CONCLUSIONS
Cystic artery erosion and pseudoaneurysm causing arteriobiliary fistula are rare vascular complications related to the biliary tree. A high index of suspicion and timely intervention is important. Trauma to arteries should be avoided during laparoscopic cholecystectomy.
Srinivasaiah
Narasimhaiah
N
Department of Surgery, North Tyneside General Hospital, Tyne and Wear, UK. simha_anu@yahoo.com
Bhojak
Maneesh
M
Jackson
Ralph
R
Woodcock
Sean
S
D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D000792:Angiography; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004630:Emergencies; D005260:Female; D005704:Gallbladder / Q000098:blood supply*; D042882:Gallstones / Q000601:surgery*; D006499:Hepatic Artery / Q000293:injuries* / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000379:methods