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胆囊切除术后由全身性癫痫引起的肝右动脉假性动脉瘤:一例报告。

Post-Cholecystectomy Right Hepatic Artery Pseudoaneurysm Induced by Generalized Seizure: A Case Report.

机构信息

Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.

Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.

出版信息

Medicina (Kaunas). 2022 Apr 21;58(5):568. doi: 10.3390/medicina58050568.

Abstract

Pseudoaneurysm is a rare complication of laparoscopic cholecystectomy (LC). In most cases, the patient presents with gastrointestinal bleeding or hemoperitoneum. Here, we present a case with a post-cholecystectomy right hepatic artery pseudoaneurysm (PSA) induced by a generalized seizure. A 39-year-old male was sent to the emergency room with a generalized seizure and a loss of consciousness for approximately 5 min. Diffuse abdominal pain was complained of after consciousness returned. The surgical history of LC 13 days prior was mentioned. Abdominal computer tomography (CT) revealed a lobulated fluid accumulation in the gallbladder fossa with prominent fatty stranding and suspected biloma formation. After admission for one week, sharp abdominal pain was observed. Abdominal CT angiography revealed a right hepatic artery pseudoaneurysm. Transcatheter arterial embolization was performed with a total of seven platinum coils. In conclusion, it is important for doctors to take pseudoaneurysm into consideration in the patient who presents with seizure attack after receiving LC. Late discovery of PSA when it is ruptured can lead to fatal conditions, such as severe hemoperitoneum.

摘要

假性动脉瘤是腹腔镜胆囊切除术(LC)的罕见并发症。大多数情况下,患者表现为胃肠道出血或腹腔积血。在这里,我们报告了一例由全身性癫痫发作引起的胆囊切除术后肝右动脉假性动脉瘤(PSA)。一名 39 岁男性因全身性癫痫发作和意识丧失约 5 分钟而被送往急诊室。意识恢复后,患者主诉弥漫性腹痛。腹部计算机断层扫描(CT)显示胆囊窝内有分叶状液体积聚,伴有明显的脂肪条纹和疑似胆汁瘤形成。LC 术后 13 天入院,一周后出现剧烈腹痛。腹部 CT 血管造影显示肝右动脉假性动脉瘤。共进行了 7 个铂金线圈的经导管动脉栓塞术。总之,对于接受 LC 后出现癫痫发作的患者,医生应考虑假性动脉瘤的可能性。PSA 破裂时,如果发现较晚,可能会导致严重的腹腔积血等致命情况。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec31/9144900/d5eb79bccc19/medicina-58-00568-g001.jpg

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