Pseudo-aneurysm of the hepatic artery after laparoscopic cholecystectomy: A case report

Iatrogenic injuries to hepatic artery system may evolve to pseudoaneurysms in the late postoperative period. Although rare, pseudoaneurysms after laparoscopic cholecystectomy can occur, are a serious clinical entity and very difficult to detect. We present a case of iatrogenic pseudoaneurysm after laparoscopic cholecystectomy. The onset of symptoms occurred 5 days after an uneventful operation. Endovascular coil embolization for a large pseudoaneurysm was unsuccessful and open surgery was conducted. Review of the literature reveals fifty-four more cholecystectomy-related pseudoaneurysms. The site of injury was the right hepatic artery in 61% of the cases and the presenting symptom was hemobilia in two-third of the patients. Embolization was performed in 82% of the cases and surgery undertaken in the remaining 18%. Knowledge of the condition should result in early diagnosis and thus limit the resultant morbidity. Embolization is the first line of treatment and surgery is reserved for more complex injuries and cases with life-threatening rupture of the aneurysm.