Vascular emergencies in cholelithiasis and cholecystectomy: our experience with two cases and literature review

Area of Science:

• Gastroenterology
• Vascular Surgery
• Interventional Radiology

Background:

• Gallstones and laparoscopic cholecystectomy pose risks of serious, potentially fatal complications if diagnosis and treatment are delayed.
• This study focuses on two rare, life-threatening vascular complications arising from gallstones and laparoscopic cholecystectomy.
• Management strategies for these critical vascular events are discussed alongside a literature review.

Observation:

• Case 1: An 81-year-old woman presented with hematemesis due to cystic arterial erosion.
• Case 2: A 57-year-old man developed hemobilia from a pseudoaneurysm of the right hepatic artery (RHA) post-laparoscopic cholecystectomy.
• Both cases represent unusual vascular issues linked to the biliary system.

Findings:

• Cystic arterial erosion was successfully managed with subtotal cholecystectomy and duodenal defect closure.
• The pseudoaneurysm causing hemobilia in the second patient was treated effectively through radiological intervention.
• Arteriobiliary fistula, stemming from pseudoaneurysm or erosion, is a rare but significant vascular complication.

Implications:

• A high index of suspicion is essential for diagnosing rare vascular complications of the biliary tree.
• Timely and appropriate intervention is critical for favorable patient outcomes.
• Minimizing arterial trauma during laparoscopic cholecystectomy is paramount to prevent such complications.