title: Management of a pseudo-aneurysm in the hepatic artery after a laparoscopic cholecystectomy.
abstract: Introduction Symptomatic hepatic-artery pseudoaneurysm (HAP) after bile-duct injury (BDI) is a rare complication with a varied (but clinically urgent) presentation. Methods A prospectively maintained database of all patients with BDI at laparoscopic cholecystectomy (LC) referred to a tertiary specialist hepatobiliary centre between 1992 and 2011 was searched systematically to identify patients with a symptomatic HAP. Care and outcome of these patients was studied. Results Eight (6 men) of 236 patients with BDI (3.4%) with a median age of 65 (range: 54?6) years presented with symptomatic HAP. Median time of presentation of the HAP from the index LC was 31 (range: 13?16) days. Bleeding was the dominant presentation in 7 patients. One patient presented late (>2 years) with abdominal pain alone. Computed tomography angiography was the most useful investigation. Angioembolisation was successful in 7 patients. One patient died, and another patient developed liver infarction. Three patients (38%) developed biliary strictures after embolisation. Seven patients are alive and well at a median follow-up of 66 months. Conclusions Presentation of HAP is often delayed. A high index of suspicion is necessary for the diagnosis. Computed tomography angiography is the first-line investigation and selective angioembolisation can yield successful outcomes.
authors: Queen Elizabeth Hospital Birmingham , UK.
authors: M P
authors: MP
authors: Senthilkumar
authors: Queen Elizabeth Hospital Birmingham , UK.
authors: N
authors: N
authors: Battula
authors: Queen Elizabeth Hospital Birmingham , UK.
authors: Mtpr
authors: M
authors: Perera
authors: Queen Elizabeth Hospital Birmingham , UK.
authors: R
authors: R
authors: Marudanayagam
authors: Queen Elizabeth Hospital Birmingham , UK.
authors: J
authors: J
authors: Isaac
authors: Queen Elizabeth Hospital Birmingham , UK.
authors: P
authors: P
authors: Muiesan
authors: Queen Elizabeth Hospital Birmingham , UK.
authors: S P
authors: SP
authors: Olliff
authors: Queen Elizabeth Hospital Birmingham , UK.
authors: D F
authors: DF
authors: Mirza
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D000792:Angiography; D001652:Bile Ducts / Q000293:injuries; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
keywords: Bile-duct injury; Cholecystectomy; Pseudoaneurysm