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Massive postoperative hemorrhage from hepatic artery erosion
Insights
An anomalous artery near the bile duct caused severe bleeding after gallbladder removal. This rare vascular anomaly led to fatal hemorrhage, highlighting potential surgical complications.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Surgical Pathology
Background:
- A 66-year-old male with a history of peptic ulcer disease underwent cholecystectomy for gallstone obstruction.
- Post-cholecystectomy complications included common bile duct exploration for residual stones.
Observation:
- An anomalous arterial structure was identified near the common bile duct during surgery.
- Postoperative hemorrhage occurred, linked to erosion of this anomalous hepatic artery.
Findings:
- Recurrent bleeding episodes, involving the hepatic artery and adjacent tissues, were observed.
- Despite initial control, fatal exsanguination resulted from stress ulcers in the gastric remnant.
- No coagulopathy was evident; the anomalous cystic artery erosion initiated the fatal cascade.
Implications:
- This case underscores the critical importance of meticulous surgical review for anomalous vasculature in the hepatobiliary region.
- Awareness of such rare arterial anomalies is crucial for preventing severe postoperative complications.
- Highlights the potential for vascular erosion to trigger catastrophic bleeding, even without underlying coagulation defects.
Abstract:
A 66-year-old male patient who had undergone repeated operations for peptic ulcer disease involving the right upper abdominal quadrant, developed cholecystitis with calculous obstruction of the common bile duct. The gallbladder was removed. Later, an operation was performed for removal of a residual stone from the common duct. At this time an anomalous arterial structure was noted about the duct. Hemorrhage occurred ten days postoperatively, and the anomalous hepatic artery was found to be eroded. The bleeding was controlled. During the succeeding two weeks there were four episodes of bleeding (involving erosion of the hepatic artery and adjacent tissues), three of which were controlled. The fourth episode ended in the death of the patient from exsanguination secondary to bleeding from stress ulcers in the gastric remnant. At no time did the laboratory data unequivocally indicate an abnormality of blood coagulation. Erosion of the anomalous cystic artery apparently precipitated the fatal chain of events.