Panda Nilanjan, Narasimhan Mohan, Gunaraj Alwin, Ardhanari Ramesh
Department of Surgery, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India.
J Minim Access Surg. 2014 Jan;10(1):37-9. doi: 10.4103/0972-9941.124471.
Vascular injuries during laparoscopic cholecystectomy can occur similar to biliary injuries and mostly represented by intraoperative bleeding. Hepatic artery system pseudoaneurysm are rare. It occurs in the early or late postoperative course. Patients present with pallor, signs of haemobillia and altered liver function. We report a case of right posterior sectoral artery pseudoaneurysm detected 2 weeks after laparoscopic cholecystectomy and successfully repaired laparoscopically. We also describe how laparoscopic pringle clamping saved the conversion. The actively bleeding right posterior sectoral artery pseudoaneurysm was diagnosed by CT angiogram. Embolisation, usually the treatment of choice, would have risked liver insufficiency as hepatic artery proper was at risk because the origin the bleeding artery was just after its bifurcation. Isolated right hepatic artery embolisation can also cause hepatic insufficiency. To our knowledge this is the first reported case of laparoscopic repair of post-laparoscopic cholecystectomy bleeding sectoral artery pseudoaneurysm.
腹腔镜胆囊切除术中的血管损伤可能与胆管损伤类似，主要表现为术中出血。肝动脉系统假性动脉瘤较为罕见。它可发生在术后早期或晚期。患者表现为面色苍白、胆道出血征象及肝功能改变。我们报告一例腹腔镜胆囊切除术后2周发现的右后段动脉假性动脉瘤，并成功进行了腹腔镜修复。我们还描述了腹腔镜肝门阻断如何避免了中转开腹。通过CT血管造影诊断出活动性出血的右后段动脉假性动脉瘤。栓塞通常是首选治疗方法，但由于出血动脉起源于肝固有动脉分叉后，栓塞肝固有动脉有导致肝功能不全的风险。孤立的右肝动脉栓塞也可导致肝功能不全。据我们所知，这是首例关于腹腔镜修复腹腔镜胆囊切除术后出血性段动脉假性动脉瘤的报道。
