Hepatic or Cystic Artery Pseudoaneurysms Following a Laparoscopic Cholecystectomy: Literature review of aetiopathogenesis, presentation, diagnosis and management

Abstract

Pseudoaneurysms (PSAs) of the hepatic and/or cystic artery are a rare complication following a laparoscopic cholecystectomy (LC). Generally, PSA cases present with haemobilia several weeks following the procedure. Transarterial embolisation (TAE) is considered the optimal management approach. We report a 70-year-old woman who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in 2016 with massive hemoperitoneum two weeks after undergoing a LC procedure in another hospital. She was successfully managed using coil TAE. An extensive literature review revealed 101 cases of hepatic or cystic artery PSAs following a LC procedure. Haemobilia was the main presentation (85.1%) and the mean time of postoperative presentation was 36 days. The hepatic artery was involved in most cases (88.1%), followed by the cystic artery (7.9%) and a combination of both (4.0%). Most cases were managed with TAE (72.3%), with a 94.5% success rate. The overall mortality rate was 2.0%.

Keywords: Hemoperitoneum; Hepatic Artery; Laparoscopic Cholecystectomy; Pseudoaneurysm; Therapeutic Embolization.

Figure 1

Computed tomography (CT) images of a 70-year-old woman two weeks after a laparoscopic cholecystectomy. A: Non-contrast CT scan of the pelvis showing hyper-dense pelvic fluid (arrow). B: Non-contrast CT scan of the upper abdomen showing a small collection of fluid in the gallbladder fossa with layering hyper-dense contents (arrow). C: Arterial-phase CT scan showing a slight irregularity (arrow) in the right hepatic artery (RHA). D: Three-dimensional CT reconstruction confirming the irregularity and focal dilatation of the RHA (arrow).

Figure 2

Selective angiograms of the hepatic artery of a 70-year-old woman two weeks after a laparoscopic cholecystectomy showing (A) focal outpouching from the right hepatic artery (RHA) at the site of origin of the cystic artery (arrow) and (B) complete obliteration of the pseudoaneurysm (arrow) following coil embolisation of the RHA.