Related Experiment Video
Updated: Sep 9, 2025
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Dual pathology, single solution: concurrent bile duct injury and hepatic artery pseudoaneurysm managed by
Burhan Zafar1, Tanveer Ul Haq1, Mallick Muhammad Zohaib Uddin1
1Radiology Department, Aga Khan University Hospital, Karachi, Pakistan.
Insights
Interventional radiology successfully managed rare concurrent bile duct injury and hepatic artery pseudoaneurysm after laparoscopic cholecystectomy. This minimally invasive approach avoided reoperation for these dual complications.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Interventional Radiology
Background:
- Laparoscopic cholecystectomy (LC) is standard for gallbladder issues but risks bile duct injury (BDI) and hepatic artery pseudoaneurysm (HAP).
- Concurrent BDI and HAP are exceptionally rare complications following LC.
Observation:
- A 31-year-old male presented with fever, vomiting, and abdominal pain 8 days post-LC, diagnosed with BDI and HAP.
- Interventional radiology (IR) performed angioembolization for HAP and CT-guided drainage for a biloma.
- Percutaneous transhepatic biliary drainage (PTBD) was required for a persistent bile leak.
Findings:
- Successful management of concurrent BDI and HAP using angioembolization and biliary drainage.
- The patient experienced significant improvement and was discharged without complications.
Implications:
- IR offers a minimally invasive alternative to reoperation for rare, dual biliary and vascular complications post-LC.
- This case highlights the effectiveness of combined angioembolization and biliary drainage in managing complex post-cholecystectomy injuries.
Introduction:
Laparoscopic cholecystectomy (LC) is the gold standard for gallbladder pathologies, but carries risks of bile duct injury (BDI) and vascular complications, such as hepatic artery pseudoaneurysm (HAP). While BDI occurs in 0.3-0.5% of cases, HAP is rare (0.8%), with concurrent injuries being exceptionally uncommon.
Case Presentation:
A 31-year-old male who developed BDI and HAP after LC was managed successfully through interventional radiology (IR). The patient was managed by LC, which was converted to an open cholecystectomy, and presented with complaints of fever, vomiting, and abdominal pain for 8 days. Angioembolization of the 4.5 mm HAP via a covered stent in the common hepatic artery and computed tomography-guided drainage of a large infected biloma were performed. Persistent bile leak required percutaneous transhepatic biliary drainage (PTBD). After the procedure, the patient's condition improved drastically, and the patient was discharged without complications.
Discussion:
IR plays a significant role in the identification and treatment of biliary lesions. IR's key part in dealing with dual complications and suggests a minimally invasive alternative to reoperation. Isolated BDI or HAP has been documented, but the co-occurrence of BDI or HAP is rare, and there is limited literature on IR-based management.
Conclusion:
The combined use of angioembolization and biliary drainage highlights a minimally invasive and effective approach to avoid the need for further surgical intervention. This case report provides valuable insight into the management of dual complications.
