Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May 5;6(1):91.
doi: 10.1186/s40792-020-00837-6.

Hemobilia-a rare complication after laparoscopic cholecystectomy

Takehiro Abiko  1 , Yuma Ebihara  2 , Motoya Takeuchi  1 , Hiroki Sakamoto  3 , Hisato Homma  3 , Satoshi Hirano  4
Affiliations

Hemobilia-a rare complication after laparoscopic cholecystectomy

Takehiro Abiko et al. Surg Case Rep. .

Abstract

Background: Biliary bleeding is a condition reported by Sandblom as hemobilia. The most common cause of hemobilia is iatrogenicity. But it has also been reported as a rare complication after laparoscopic cholecystectomy (LC).

Case presentation: A man in his 60s underwent a LC. He was taking a direct Xa inhibitor for paroxysmal atrial fibrillation (pAf) and had a history of thrombectomy. There was variation in the bifurcation of the hepatic artery and cystic artery. The right hepatic artery branches from the common hepatic artery by itself, and the cystic artery is double. He complained of right upper quadrant pain, nausea, and vomiting on the third postoperative day (3POD). Non-contrast computed tomography (CT) showed that a high absorption area was found to fill the common bile duct. Contrast CT showed no pseudoaneurysm formation. Ultimately, he was diagnosed with postoperative hemobilia. Angiographic examination selective for the cystic artery branching from the middle hepatic artery revealed leakage of the contrast agent and a micro-pseudoaneurysm.

Conclusions: We encountered a case of hemobilia after LC. In this case, it was presumed that in addition to the chronic inflammatory changes of the gallbladder wall, extraordinary bifurcation of the hepatic artery and the cystic arteries and easy bleeding due to resumption of a direct Xa inhibitor synergistically caused a micro-pseudoaneurysm and postoperative hemobilia. It was difficult to identify the cause of hemobilia by contrast CT alone. Angiographic examination was useful for identifying and treating the causative artery and needs to perform aggressively.

Keywords: Double cystic artery; Hemobilia; Laparoscopic cholecystectomy.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Contrast CT before LC. a The gallbladder was filled with debris. b Cystic artery diverged from the middle hepatic artery
Fig. 2
Fig. 2
Non-contrast CT after LC. Non-contrast CT showed that a high absorption area filled the common bile duct
Fig. 3
Fig. 3
Contrast CT after LC. Contrast CT showed no leakage of the contrast agent and pseudoaneurysm formation
Fig. 4
Fig. 4
Angiographic examination. a Angiographic examination selective for the cystic artery branching from the middle hepatic artery revealed leakage of the contrast agent into the remaining lumen of the gallbladder neck and a micro-pseudoaneurysm. b Embolization of the cystic artery branching from the middle hepatic artery
See this image and copyright information in PMC

References

    1. Sandblom P. Hemorrhage into biliary tract following trauma; traumatic hemobilia. Surgery. 1948;24:571–586. - PubMed
    1. Grove WJ. Biliary tract hemorrhage as a cause of hematemesis. Arch Surg. 1961;83:67–72. doi: 10.1001/archsurg.1961.01300130071008. - DOI - PubMed
    1. Green MH, Duell RM, Johnson CD, Jamieson NV. Haemobilia. Br J Surg. 2001;88:773–786. doi: 10.1046/j.1365-2168.2001.01756.x. - DOI - PubMed
    1. Pouwels S, Kanters C, le Haen PA, Poelman M. Acute biliary pancreatitis haemobilia due to a false aneurysm of the right hepatic artery after laparoscopic cholecystectomy. BMJ Case Rep. 2018;16. - PMC - PubMed
    1. Machado NO, Al-Zadjali A, Kakaria AK, Younus S, Rahim MA, Al-Sukaiti R. Hepatic or Cystic Artery Pseudoaneurysms Following a Laparoscopic Cholecystectomy: Literature review of aetiopathogenesis, presentation, diagnosis and management. Sultan Qaboos Univ Med J. 2017;17:e135–e146. - PMC - PubMed

LinkOut - more resources