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Case Reports
. 2022 Mar 23;22(1):112.
doi: 10.1186/s12893-021-01438-2.

Recurrent right hepatic artery pseudoaneurysm after robotic-assisted cholecystectomy in a patient with Mirizzi syndrome: a case report

Ted Hsiung  1 , Tsung-Shih Lee  2 , Yueh-Lin Lee  3 , Ting-Shuo Huang  1 , Chih-Yuan Wang  4
Affiliations
Case Reports

Recurrent right hepatic artery pseudoaneurysm after robotic-assisted cholecystectomy in a patient with Mirizzi syndrome: a case report

Ted Hsiung et al. BMC Surg. .

Abstract

Background: Iatrogenic hepatic artery pseudoaneurysm is a rare complication following laparoscopic cholecystectomy. Trans-arterial embolization (TAE) is an effective way to control bleeding after a ruptured aneurysm. But uncommonly, rebleeding may occur which will require a second embolization or even laparotomy.

Case presentation: We report a case of a 45-year-old woman who underwent robotic-assisted cholecystectomy after the diagnosis of type II Mirizzi syndrome. During the operation, the anterior branch of the right hepatic artery was damaged and Hem-o-lok clips were applied to control the bleeding. The postoperative course was smooth, and the patient was discharged 6 days after the procedure. However, one week after hospital discharge, she presented to the emergency department with right upper abdominal tenderness, melena, and jaundice. After examination, the computed tomography angiography (CTA) revealed a 3 cm pseudoaneurysm at the distal stump of the right hepatic artery anterior branch. TAE with gelfoam material was performed. Three days later, the patient had an acute onset of abdominal pain. A recurrent pseudoaneurysm was found at the same location. She underwent TAE again but this time with a steel coil. No further complication was noted, and she was discharged one week later.

Conclusions: Even with the assistance of modern technologies such as the robotic surgery system, one should still take extra caution while handling the vessels. Also, embolization of the pseudoaneurysm with steel coils may be suitable for preventing recurrence.

Keywords: Case report; Iatrogenic hepatic artery pseudoaneurysm; Mirizzi syndrome; Robotic-assisted surgery.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A a 2 × 2 cm stone (thin white arrow) impacted between the cystic duct and common bile duct (CBD). The thick white arrow indicates the severely contracted gall bladder. B Coronal view revealed the impacted stone causing compression of the CBD
Fig. 2
Fig. 2
The proximal and distal stump of the posterior branch of the right hepatic artery were controlled by Hem-o-lok
Fig. 3
Fig. 3
A The first angiogram revealed a 3 cm pseudoaneurysm (black arrow) located in the distal stump of the right hepatic artery anterior branch, supplied by the posterior branch of the right hepatic artery due to rich anastomosis. B The second angiogram revealed a recurrent pseudoaneurysm located in the same region, supplied by the GDA collateral vessels
See this image and copyright information in PMC

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