Department of Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila.
Department of Radiology, S. Salvatore Hospital, L'Aquila.
Acta Biomed. 2021 Apr 30;92(S1):e2021125. doi: 10.23750/abm.v92iS1.10821.
The laparoscopic approach has become the gold standard for cholecystectomy. However, it could have some major complications. Among them, it can be considered postoperative pseudoaneurysms of the cystic or hepatic arteries. Haemobilia secondary to a cystic artery pseudoaneurysm is extremely rare.
Here we present a case from our centre of haemobilia in association with a cystic artery pseudoaneurysm, as a late complication of VLC. An 18-year-old girl underwent laparoscopic cholecystectomy; during surgery, due to viscero-perietal tight adhesions and due to the close proximity of the cystic duct to the biliary ducts, we suspected a bile duct injury. So, decision was taken to convert to open surgery: a suture was performed to repair the coledocic duct injury and an endoscopic papillotomy was performed with subsequent positioning of an endoscopic plastic biliary endoprothesis at the hepatocholedochus. One month after surgery, the patient showed clinical signs of hypovolemic shock. She underwent Computed Tomography Angiography, showing a possible arterial lesion, just adjacent to surgical clip. Therefore, patient underwent angiographic examination, which confirmed an 8 mm pseudoaneurysm arising from cystic artery, just adjacent to surgical clips. Superselective catheterization of vessel was performed, and two coils were released, until obtaining complete exclusion of the vascular lesion. The patient was discharged five days after procedure, with good general condition.
Pseudoaneurysms of the cystic artery are uncommon entities, rarely reported in the literature, and often caused by cholecystitis or iatrogenic biliary injury. All conditions that are responsible for vessels' injuries could also cause haemobilia. Even if pseudoaneurysm of cystic artery with haemobilia is a rare event, it has to be considered as a complication of VLC. Angiographic approach should be the treatment of choice.
腹腔镜方法已成为胆囊切除术的金标准。然而，它可能会有一些严重的并发症。其中，可以考虑为术后胆囊或肝动脉假性动脉瘤。继发于胆囊动脉假性动脉瘤的胆血症极为罕见。
我们在此介绍了一个来自我们中心的病例，该病例与胆囊动脉假性动脉瘤有关，是 VLC 的晚期并发症。一名 18 岁女孩接受了腹腔镜胆囊切除术；手术中，由于内脏壁层粘连紧密，并且胆囊管靠近胆管，我们怀疑胆管损伤。因此，决定转为开腹手术：对胆总管进行缝合修复，并进行内镜乳头切开术，随后在内镜下放置塑料胆道内支架。手术后一个月，患者出现低血容量性休克的临床症状。她进行了计算机断层血管造影（CTA），显示可能存在动脉病变，正好毗邻手术夹。因此，患者接受了血管造影检查，证实了一个 8 毫米的假性动脉瘤起源于胆囊动脉，正好毗邻手术夹。对血管进行了超选择性导管插入术，并释放了两个线圈，直到完全排除血管病变。患者在手术后五天出院，一般情况良好。
胆囊动脉假性动脉瘤是一种罕见的实体，在文献中很少报道，通常由胆囊炎或医源性胆道损伤引起。所有导致血管损伤的情况也可能导致胆血症。即使是胆囊动脉假性动脉瘤伴胆血症也是 VLC 的一种罕见并发症，也应被视为 VLC 的一种并发症。血管造影方法应是首选治疗方法。
