Hemobilia-a rare complication after laparoscopic cholecystectomy

Area of Science:

• Gastroenterology
• Surgical Complications
• Vascular Anatomy

Background:

• Hemobilia, or biliary bleeding, is a rare complication following laparoscopic cholecystectomy (LC).
• Iatrogenic causes are the most frequent contributors to hemobilia.

Purpose of the Study:

• To present a case of hemobilia after LC.
• To highlight the diagnostic challenges and treatment strategies for this rare complication.

Main Methods:

• A case study of a male patient in his 60s who underwent LC.
• Patient had a history of paroxysmal atrial fibrillation treated with a direct Xa inhibitor and prior thrombectomy.
• Diagnostic imaging included non-contrast and contrast CT, followed by selective angiography of the cystic artery.

Main Results:

• The patient presented with post-operative symptoms including right upper quadrant pain, nausea, and vomiting.
• CT scans revealed a high-absorption area in the common bile duct, but no pseudoaneurysm.
• Angiography identified contrast leakage and a micro-pseudoaneurysm in the cystic artery, confirming hemobilia.

Conclusions:

• Postoperative hemobilia in this case was attributed to a combination of factors: chronic gallbladder inflammation, unusual hepatic and cystic artery anatomy, and anticoagulation therapy.
• Contrast-enhanced CT alone was insufficient for diagnosis; angiography was essential for identifying the bleeding source.
• Aggressive use of angiography is recommended for the diagnosis and treatment of post-cholecystectomy hemobilia.