An Unusual Case of Partially Thrombosed Right Hepatic Artery Pseudoaneurysm Following Laparoscopic Cholecystectomy: A Case Report.

Shailesh Rathee; Shweta Aggarwal; Shamim Ahmad; Zahid Salim Ahmad; Gaurav Prakash

doi:10.51168/sjhrafrica.v7i2.2773

Authors

Dr. Shailesh Rathee Radiology Resident, Department of Radio Diagnosis, Narayan Medical College & Hospital, Sasaram, Bihar.
Dr. Shweta Aggarwal Senior Resident, Department of Radio Diagnosis, SNMC, Jodhpur, Rajasthan. E mail id: aggarwaldrshweta@gmail.com
Dr. (Prof.) Md. Shamim Ahmad HOD, Department of Radio Diagnosis, Narayan Medical College & Hospital, Sasaram, Bihar.
Dr. Zahid Salim Ahmad Assistant Professor, Department of Radio Diagnosis, Narayan Medical college & Hospital, Sasaram, Bihar
Dr. Gaurav Prakash Assistant Professor. Department of Radio Diagnosis, Narayan Medical College & Hospital.

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2773

Keywords:

Hepatic artery pseudoaneurysm, Laparoscopic cholecystectomy, Color Doppler ultrasound, CT angiography, MRCP (Magnetic Resonance Cholangiopancreatography), Digital subtraction angiography, Endovascular embolization

Abstract

Background:

Laparoscopic cholecystectomy in most cases does not cause vascular complications, but when it does, these can be serious and life-threatening. Hepatic artery pseudoaneurysm is a rare iatrogenic complication caused by thermal injury, clip erosion, vascular trauma, or infection. Early diagnosis prevents rupture, hemobilia, biliary obstruction, and hemorrhagic shock.

Case Presentation:

A 67-year-old female patient came to hospital with a persistent abdominal pain and a lump palpable in the right upper quadrant, four weeks after undergoing a Laparoscopic cholecystectomy for cholelithiasis at an outside hospital. She did not have any of the following: jaundice, gastrointestinal bleeding, fever, or hemodynamic instability. Ultrasonography showed anechoic collections in the gall bladder fossa which was approximately 71.2 × 40 × 35 mm with the presence of peripheral mural thrombus in the collection. Color Doppler showed turbulent arterial flow with a characteristic “yin-yang” sign, which showed a partially thrombosed pseudoaneurysm. Contrast-enhanced computed tomography (CECT) revealed a focal outpouching with progressive enhancement in the arterial and venous phase that showed contrast material. Peripheral thrombus was depicted by a surrounding non-enhancing component. The lesion was located outside the liver above the surgical clips. MRI and angiography confirmed a partially thrombosed right hepatic artery pseudoaneurysm compressing the bile duct. The patient was successfully treated with coil embolization, with complete resolution on follow-up ultrasound.

Conclusion:

Post laparoscopic cholecystectomy pseudoaneurysm of the right hepatic artery is a rare, but serious complication. Doppler ultrasonography is a useful first-line diagnostic tool, and computed tomography angiography, MRI, MRCP and digital subtraction angiography are useful for detailed characterization. Quick recognition and endovascular embolisation provide excellent clinical results and reduce catastrophic hemorrhagic complications.

References

Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy: a national survey of 77604 cases. Am J Surg. 1993;165(1):9-14. doi:10.1016/S0002-9610(05)80397-6.

Stewart L, Robinson TN, Lee CM, Liu K, Whang K, Way LW. Right hepatic artery injury associated with laparoscopic bile duct injury: incidence, mechanism, and consequences. Journal of Gastrointestinal Surgery. 2004;8(5):523-531. https://doi.org/10.1016/j.gassur.2004.02.010

Christensen T, Matsuoka L, Heestand G, Palmer S, Mateo R, Genyk Y, Selby R, Sher L. Iatrogenic pseudoaneurysms of the extrahepatic arterial vasculature: management and outcome. HPB (Oxford). 2006;8(6):458-64. doi: 10.1080/13651820600839993.

Machado NO. Biliary complications post laparoscopic cholecystectomy: mechanism, preventive measures and management. Diagn Ther Endosc. 2011;2011:967017. doi:10.1155/2011/967017.

Lee H, Han IW, Choi JE, Lee HK. Surgical risk calculator development for postoperative outcomes after laparoscopic cholecystectomy: a multicenter prospective cohort study. Ann Surg Treat Res. 2025 Jun;108(6):352-361. doi: 10.4174/astr.2025.108.6.352.

Machado NO, Al-Zadjali A, Kakaria AK, Younus S, Rahim MA, Al-Sukaiti R. Hepatic or Cystic Artery Pseudoaneurysms Following a Laparoscopic Cholecystectomy: Literature review of aetiopathogenesis, presentation, diagnosis and management. Sultan Qaboos Univ Med J. 2017 May;17(2):e135-e146. doi: 10.18295/squmj.2016.17.02.002. Epub 2017 Jun 20. PMID: 28690884; PMCID: PMC5488813.

Cordova AC, Sumpio BE. Visceral Artery Aneurysms and Pseudoaneurysms—Should They All be Managed by Endovascular Techniques? Ann Vasc Dis. 2013;6(4):687-93. doi: 10.3400/avd.ra.13-00045. Epub 2013 Nov 15. PMID: 24386016; PMCID: PMC3866356.

Casazza I, Guglietta MA, Argento G. Magnetic resonance cholangiopancreatography in the diagnosis of haemobilia. Case Rep Radiol. 2013;2013:792109. doi: 10.1155/2013/792109. Epub 2013 Dec 22. PMID: 24455379; PMCID: PMC3881441.

Mahmoud MZ, Al-Saadi M, Abuderman A, Alzimami KS, Alkhorayef M, Almagli B, Sulieman A. "To-and-fro" waveform in the diagnosis of arterial pseudoaneurysms. World J Radiol. 2015 May 28;7(5):89-99. doi: 10.4329/wjr.v7.i5.89. PMID: 26029351; PMCID: PMC4444605.

Cacciatore J, Gonzalez S, Briley K, Ali S, Molano MDPB, Viradia N. Hepatic artery pseudoaneurysms: Two cases, 2 novel solutions, and a brief review of current treatments. Radiol Case Rep. 2025 Nov 13;21(2):526-531. doi: 10.1016/j.radcr.2025.10.068. PMID: 41323178; PMCID: PMC12661396.

Chadha M, Ahuja C. Visceral artery aneurysms: diagnosis and percutaneous management. Semin Intervent Radiol. 2009 Sep;26(3):196-206. doi: 10.1055/s-0029-1225670. PMID: 21326564; PMCID: PMC3036493.

Campos Carmona T, Teran Hooper C, Abbagoni V, et al. (November 04, 2024) Hemobilia: A Narrative Review of Current Diagnostic Techniques and Emerging Management Strategies. Cureus 16(11): e73009. DOI 10.7759/cureus.73009

Loffroy R, Favelier S, Pottecher P, Genson PY, Estivalet L, Gehin S, Cercueil JP, Krausé D. Endovascular management of visceral artery aneurysms: When to watch, when to intervene? World J Radiol. 2015 Jul 28;7(7):143-8. doi: 10.4329/wjr.v7.i7.143.

Abbas MA, Fowl RJ, Stone WM, Panneton JM, Oldenburg WA, Bower TC. Hepatic artery aneurysm: factors predicting complications. Journal of Vascular Surgery. 2003;38(1):41-45. https://doi.org/10.1016/S0741-5214(03)00090-9

Tulsyan N, Kashyap V, Greenberg R et al. The endovascular management of visceral artery aneurysms and pseudoaneurysms. Journal of Vascular Surgery. 2007;45, 276-283. DOI: 10.1016/j.jvs.2006.10.049

Pyra K, Szmygin M, Sojka M, Drelich-Zbroja A, Jargiełło T. Endovascular treatment of visceral artery aneurysms and pseudoaneurysms - evaluation of efficacy and safety based on long-term results. Pol Przegl Chir. 2019;92(1):23-28. doi: 10.5604/01.3001.0013.5895.