VCOM Louisiana Research Day Program

Clinical & Case Studies

Mihir Patel, OMS-III; Anish Gupta, OMS-III Willis Knighton Health Systems 17 LAPAROSCOPIC CHOLECYSTECTOMY INDUCED HEPATIC ARTERY PSEUDOANEURYSM

A hepatic artery pseudoaneurysm (HAP), which is often life threatening. An outpouching can result from arterial wall damage and lead to a sac filled with blood. In contrast with a true aneurysm, which contains all three layers of the artery (intima, media, adventitia), a HAP contains only 1 or 2 layers of the arterial wall. Because of the instability, the risk of rupture is higher than that of a true aneurysm of comparable size. The formation of HAP is rare incidence around 0.06-0.6%, but rupture occurs in around 76% of patients and the mortality of patients requiring operative intervention is 75%. Due to the sinister nature of the HAP, it is important to be familiar with signs, symptoms and precipitating factors that can lead to early identification. In this case, a 65-year old male presented to the ED with a history of vomiting, abdominal pain, and jaundice. The patient had undergone a laparoscopic cholecystectomy 3 weeks prior to the onset of these symptoms. The patient was also tachycardic, hypotensive, and febrile. At ED, ultrasound and CT were both ordered. The contrast CT showed a hyperattenuating smooth-walled sac present adjacent to the proximal hepatic artery- consistent with a pseudoaneurysm. On Doppler ultrasound, a characteristic yin-yang/pepsi sign may be visible, indicating bidirectional flow due to the

swirling of blood within the aneurysm.

In conclusion, laparoscopic cholecystectomy is a commonly performed surgical procedure that has proven to be a safe and effective method for the treatment of gallbladder disease. However, like all surgical procedures, it is not without its risks. One potential complication is the formation of hepatic artery pseudoaneurysm, a rare but serious complication that can lead to life threatening bleeding. The prompt diagnosis and management of hepatic artery pseudoaneurysm following laparoscopic cholecystectomy is crucial in preventing catastrophic outcomes. Timely intervention with endovascular embolization or surgical repair can successfully treat the pseudoaneurysm and prevent further complications.

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