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

Hepatobiliary & Pancreatic Diseases International 2008年第2期7卷 217-220页

作者： Narasimhaiah Srinivasaiah maneesh bhojak Ralph Jackson Sean Woodcock Department of Surgery North Tyneside General Hospital Tyne and Wear UK Department of Radiology Freeman Hospital Tyne and Wear UK

BACKGROUND:Complications from gallstones and laparoscopic cholecystectomy can be serious and fatal if there is a delay in recognition and treatment. We aim to present two unusual, life threatening vascular complications as a result of gallstones and laparoscopic cholecystectomy. Their management is highlighted with a brief review of literature. METHODS:Data for the article were gathered from clinical case note review. Radiology database was used for images. A brief literature review was undertaken using Pubmed search. The keyword used included hemobilia, pseudoaneurysm, arterio-biliary fistula and laparoscopic cholecystectomy. RESULTS:The article highlights two individual case reports. The first case constitutes an 81-year woman who had cystic arterial erosion causing hematemesis, while the second patient was a 57-year man who presented with hemobilia from a pseudoaneurysm of right hepatic artery (RHA) following laparoscopic cholecystectomy. Cystic arterial erosion was treated with subtotal cholecystectomy with duodenal defect closure while the pseudoaneurysm underwent radiological intervention. CONCLUSIONS:Cystic artery erosion and pseudoaneurysm causing arteriobiliary fistula are rare vascular complications related to the biliary tree. A high index of suspicion and timely intervention is important. Trauma to arteries should be avoided during laparoscopic cholecystectomy.

关键词： laparoscopic cholecystectomy hemobilia hematemesis pseudoaneurysm

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