False aneurysm of the hepatic artery after laparoscopic cholecystectomy

A rare complication of laparoscopic cholecystectomy is defined: iatrogenic injuries to hepatic artery system which may evolve to pseudoaneurysms in the late postoperative period. This rare phenomenon may be overlooked and pose a challenge to surgeons.

We will describe three cases with iatrogenic pseudoaneurysms after laparoscopic cholecystectomy. The onset of symptoms and the course of the disease was not uniform. Diagnosis was made after a considerable delay. In the first case, a small, uncomplicated extrahepatic pseudoaneurysm was successfully treated with coil embolization. The second patient who had an intrahepatic pseudoaneurysm with multiple injuries to the common bile duct and portal vein, did not survive despite surgical and endovascular interventions. In the latter, surgical treatment for a large pseudoaneurysm that had ruptured into the liver parenchyma was successfully conducted. Review of the literature reveals fifty-four more cholecystectomy-related pseudoaneurysms. The site of injury was the right hepatic artery in 61% of the cases and the presenting symptom was upper gastrointestinal bleeding (haemobilia) in two-third of the patients. Embolization was performed in 82% of the cases, and surgery was undertaken in the remaining 18%.

Pseudoaneurysm is an uncommon complication of laparoscopic cholecystectomy. Prompt attention is necessary since the lesion has a high risk of rupture. Embolization is the first line of treatment and surgery is reserved for more complex injuries and cases with life-threatening rupture of the aneurysm.