Hepatic Artery Pseudoaneurysm Presenting as Gastrointestinal Hemorrhage

Abstract

A hepatic artery pseudoaneurysm (HAP) is a rare complication of laparoscopic cholecystectomy. It can vary in its clinical presentation; however, given its severe nature, prompt assessment and management are crucial. We report a case of a 73-year-old male who underwent a laparoscopic cholecystectomy complicated by a right hepatic artery injury. This subsequently presented as a life-threatening case of upper gastrointestinal bleeding from HAP, with presumable hemobilia and septic shock from multiple liver abscesses. The diagnosis was made with computed tomography angiography (CTA) of the abdomen and pelvis followed by visceral angiography. The patient ultimately underwent a right hepatectomy for definitive treatment. The primary objective of this case is to highlight a less novel, though rare, case presentation and define a spectrum of treatment options available based on severity.

Keywords: gastrointestinal bleeding; hepatectomy; hepatic artery pseudoaneurysm; right hepatectomy.

Figure 1. Axial view hepatic artery pseudoaneurysm seen on CTA abdomen

Red arrow pointing to the hepatic artery pseudoaneurysm as seen on an axial view on CTA abdomen. computed tomography angiography (CTA)

Figure 2. Axial view of clipped right hepatic artery seen on CTA abdomen

This figure demonstrates the common hepatic artery branching into the right and left hepatic arteries. A red arrow is pointing toward the right hepatic artery, which was ligated and clipped during the patient's initial surgery. computed tomography angiography (CTA)

Figure 3. Common hepatic angiogram revealing hepatic artery pseudoaneurysm

Images obtained during visceral angiography with the orange arrow indicating the prior clipping of the right hepatic artery and the black arrow indicating the pseudoaneurysm.

Figure 4. Digital subtraction angiography of the common hepatic artery

This image shows digital subtraction angiography of the common hepatic artery with the black arrow pointing to the hepatic artery pseudoaneurysm, the orange arrow pointing to prior ligation and clips placed on the right hepatic artery, and the blue arrow pointing to the common hepatic artery.