Surgical Treatment of Pseudoaneurysm of the Right Hepatic Artery Following Cholecystectomy: A Case Report

Abstract

Pseudoaneurysms of the right hepatic artery following cholecystectomy are caused by either vascular damage or erosion after a biliary leak. Symptoms often include haemobilia, melena, vomiting, jaundice, and hemodynamic failure due to aneurysm rupture. The ideal treatment is arterial embolization or, in rare cases, stenting. We present a case of pseudoaneurysm of the right hepatic artery post-laparoscopic cholecystectomy. The patient presented with abdominal pain, vomiting, and hemodynamic failure on postoperative day 45. Magnetic resonance imaging (MRI) showed a large hematoma and a pseudoaneurysm of the right hepatic artery. A laparotomy was performed, and a large hematoma was found and evacuated. After the pringle maneuver, the pseudoaneurysm was resected. The right hepatic artery was ligated with clips, and a sub-hepatic drain was placed. The non-availability of emergency embolization forced surgical closure of the right hepatic artery, which is still the first-line treatment for such cases. Injury of the right hepatic artery is a rare complication, often overlooked by surgeons, and requires early diagnosis. Surgical treatment is reserved for cases of embolization failure or hemodynamic instability.

Keywords: complications; laparoscopic cholecystectomy; pseudoaneurysm; right hepatic artery; surgical ligation.

Figure 1. Magnetic resonance imaging showing pseudoaneurysm of the right hepatic artery (arrow) with large hematoma.

Figure 2. Per-operative findings. (A) Pseudoaneurysm (arrow) with large hematoma. (B) Injury of the right hepatic artery after dissection (arrow). (C) Ligation of the right hepatic artery with clips (arrow).