Abstract
This report describes injury to the hepatic artery with pseudoaneurysm formation and hemobilia following the use of laser-assisted dissection to perform laparoscopic cholecystectomy.
A 57-year-old woman was referred emergently 2 weeks after laser laparoscopic cholecystectomy with upper abdominal pain, upper gastrointestinal bleeding, and jaundice. A selective hepatic arteriogram showed a right hepatic artery pseudoaneurysm which was embolized. Two weeks later the patient had recurrent hemobilia as the result of blood flow restoration in the pseudoaneurysm and a fistula to the cystic duct remnant. She was treated with two additional embolizations and direct injection of the aneurysm with thrombogenic material. Follow-up at 2 years showed no further recurrence.
Since the laser has never been shown to have advantages over electrocautery, its use during laparoscopic cholecystectomy is difficult to justify.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Allison DJ (1988) Embolization of liver tumors. In: Blumgart LH (ed) Surgery of the liver and biliary tract. Churchill Livingstone, Edinburgh, pp 1201–1217
Curet P, Baumer R, Roche A, Grellet J, Mercadier M (1984) Hepatic hemobilia of traumatic or iatrogenic origin: recent advances in diagnosis and therapy, review of the literature from 1976 to 1981. World J Surg 8: 2–8
Czerniak A, Thompson JN, Hemingway AP, Soreide O, Benjamin IS, Allison DJ, Blumgart LH (1988) Hemobilia: a disease in evolution. Arch Surg 123: 718–721
Easter DW, Moossa AR (1991) Laser and laparoscopic cholecystectomy. Arch Surg 126: 423
Hodgson WJB, Sandblom P, Johansen K (1987) Biliary tract bleeding. Probl Gen Surg 4: 347–353
Hunter JG (1991) Laparoscopic cholecystectomy: laser or electrocautery? Probl Gen Surg 8: 409–415
Jeans PL (1988) Hepatic artery aneurysms and biliary surgery: two cases and a literature review. Aust N Z J Surg 58: 889–894
Perissat J, Collet D, Belliard R, Desplantez J, Magne E (1992) Laparoscopic cholecystectomy: the state of the art. A report of 700 consecutive cases. World J Surg 16: 1074–1082
Ponsky JL (1991) Pitfalls in laparoscopic cholecystectomy. Probl Gen Surg 8: 320–328
Psathakis D, Muller G, Noah M, Diebold J, Bruch HP (1992) Present management of hepatic artery aneurysm. Symptomatic left hepatic artery aneurysm; right hepatic artery aneurysm with erosion into the gallbladder and simultaneous colocholecystic fistula — a report of two unusual cases and the current state of etiology, diagnosis, histology and treatment. Vasa 21: 210–215
Salam TA, Lumsden AB, Martin LG, Smith III RB (1992) Non-operative management of visceral aneurysms and pseudoaneurysms. Am J Surg 164: 215–219
Sandblom P (1986) Iatrogenic hemobilia. Am J Surg 151: 754–758
Sandblom P (1988) Hemobilia. In: Blumgart LH (ed) Surgery of the liver and biliary tract. Churchill Livingstone, Edinburgh, pp 1075–1089
Smith JA, Macleish DG, Collier NA (1989) Aneurysms of the visceral arteries. Aust N Z J Surg 59: 329–334
Stone HH (1988) Trauma to the liver vasculature. Aneurysm and arteriovenous fistula. In: Blumgart LH (ed) Surgery of the liver and biliary tract. Churchill Livingstone, Edinburgh, pp 1063–1074
Voyles CR, Meena AL, Petro AB, Haick AJ, Koury AM (1990) Electrocautery is superior to laser for laparoscopic cholecystectomy. Am J Surg 160: 457
Yoshida J, Donahue PE, Nyhus LM (1987) Hemobilia: review of recent experience with a worldwide problem. Am J Gastroenterol 82: 448–453
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Genyk, Y.S., Keller, F.S. & Halpern, N.B. Hepatic artery pseudoaneurysm and hemobilia following laser laparoscopic cholecystectomy. Surg Endosc 8, 201–204 (1994). https://doi.org/10.1007/BF00591830
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00591830