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IMAGE QUIZ
Year : 2015  |  Volume : 3  |  Issue : 3  |  Page : 247-249

Post laparoscopic cholecystectomy hematemesis


Hepatobiliary and Transplant Surgeon, Assistant Professor of Surgery, Department of Surgery, College of Medicine, University of Dammmam, King Fahd Hospital of the University, Dammam, Kingdom of Saudi Arabia

Date of Web Publication3-Aug-2015

Correspondence Address:
Hanan M Alghamdi
University of Dammam, King Fahd Hospital of the University, P. O. Box 40020, Al-Khobar 31952
Kingdom of Saudi Arabia
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DOI: 10.4103/1658-631X.162043

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How to cite this article:
Alghamdi HM. Post laparoscopic cholecystectomy hematemesis. Saudi J Med Med Sci 2015;3:247-9

How to cite this URL:
Alghamdi HM. Post laparoscopic cholecystectomy hematemesis. Saudi J Med Med Sci [serial online] 2015 [cited 2020 Nov 27];3:247-9. Available from: https://www.sjmms.net/text.asp?2015/3/3/247/162043

A 27-yar-old woman underwent laparoscopic cholecystectomy. One week later, she presented with abdominal pain and tachycardia. The emergency laparotomy showed bleeding in the surgical bed. Hemostasis was achieved and drain inserted. The drain output was bilious in the first postoperative day. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and revealed a bile duct leak and stent was inserted. Six weeks later, the patient presented with massive hematemesis. Selected angiogram shown in [Figure 1] and computed tomography (CT) scan is depicted in [Figure 2]. After the initial management, the patient was discharged home, but she came back 3 weeks later with another episode of hematemesis. A second selective angioembolization [Figure 3] failed to resolve her condition.
Figure 1: Selective angiogram showing biliary stent and the cause of the patient hematemesis and intervention.

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Figure 2: Computed tomography scan with contrast showing the surgical clips and extravasation of contrast.

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Figure 3: The second selective angiogram showing persistent finding and repeated intervention done.

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  Questions Top


What is the cause of her presentation?

What is the cause of the complications?

What is the possible diagnosis?



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  References Top

1.
Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy: A national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 1993;165:9-14.  Back to cited text no. 1
    
2.
Stewart BT, Abraham RJ, Thomson KR, Collier NA. Post-cholecystectomy haemobilia: Enjoying a renaissance in the laparoscopic era? Aust N Z J Surg 1995;65:185-8.  Back to cited text no. 2
    
3.
Ribeiro A, Williams H, May G, Fulmer JT, Spivey JR. Hemobilia due to hepatic artery pseudoaneurysm thirteen months after laparoscopic cholecystectomy. J Clin Gastroenterol 1998;26:50-3.  Back to cited text no. 3
    
4.
Genyk YS, Keller FS, Halpern NB. Hepatic artery pseudoaneurysm and hemobilia following laser laparoscopic cholecystectomy. A case report. Surg Endosc 1994;8:201-4.  Back to cited text no. 4
    
5.
Bergey E, Einstein DM, Herts BR. Cystic artery pseudoaneurysm of the right hepatic artery: A rare complication of laparoscopic cholecystectomy. Langenbecks Arch Chir 1995;379:291-3.  Back to cited text no. 5
    
6.
Ibrarullah M, Singh B, Mehrotra P, Kaushik SP. Right hepatic artery pseudoaneurysm after laparoscopic cholecystectomy. Am J Gastroenterol 1997;92:528-9.  Back to cited text no. 6
    
7.
Yelle JD, Fairfull-Smith R, Rasuli P, Lorimer JW. Hemobilia complicating elective laparoscopic cholecystectomy: A case report. Can J Surg 1996;39:240-2.  Back to cited text no. 7
    
8.
Porte RJ, Coerkamp EG, Koumans RK. False aneurysm of a hepatic artery branch and a recurrent subphrenic abscess: Two unusual complications after laparoscopic cholecystectomy. Surg Endosc 1996;10:161-3.  Back to cited text no. 8
    
9.
Rivitz SM, Waltman AC, Kelsey PB. Embolization of an hepatic artery pseudoaneurysm following laparoscopic cholecystectomy. Cardiovasc Intervent Radiol 1996;19:43-6.  Back to cited text no. 9
    
10.
Siablis D, Tepetes K, Vasiou K, Karnabatidis D, Perifanos S, Tzorakoleftherakis E. Hepatic artery pseudoaneurysm following laparoscopic cholecystectomy: Transcatheter intraarterial embolization. Hepatogastroenterology 1996;43:1343-6.  Back to cited text no. 10
    
11.
Pistorius GA, Walter P, Hildebrant U, Defreyne L. Pseudoaneurysm of the right hepatic artery: A rare complication of laparoscopic cholecystectomy. Langenbecks Arch Chir 1994;379:291-3.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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