The 'nick' or 'clip'? A giant hepatic artery pseudoaneurysm complicating laparoscopic cholecystectomy

Right hepatic artery pseudoneurysm (HAPA) is a rare but potentially lethal complication following laparoscopic cholecystectomy. Its incidence is as low as 0.6%-0.8% and usually presents within the first month following the surgery due to iatrogenic injury to the concerned artery. A high index of suspicion is essential since it may often be missed leading to a catastrophic outcome. Often a contrast-enhanced computer-aided tomography of the abdomen done as evaluation of postcholecystectomy state suggests a pseudoanerysm. We report a single case of a 27-year-old female who presented to us and deteriorated rapidly due to a ruptured right HAPA, with an acute abdomen and melena, who was surgically managed by exploration and excision of the pseudoaneurysmal sac due to unavailability of transarterial embolization. During surgery, the cystic artery metal clip was seen eroding in hepatic artery producing pseudoanerysm.