Dual pathology, single solution: concurrent bile duct injury and hepatic artery pseudoaneurysm managed by interventional radiology after converted cholecystectomy.

INTRODUCTION

Laparoscopic cholecystectomy (LC) is the gold standard for gallbladder pathologies, but carries risks of bile duct injury (BDI) and vascular complications, such as hepatic artery pseudoaneurysm (HAP). While BDI occurs in 0.3-0.5% of cases, HAP is rare (0.8%), with concurrent injuries being exceptionally uncommon.

CASE PRESENTATION

A 31-year-old male who developed BDI and HAP after LC was managed successfully through interventional radiology (IR). The patient was managed by LC, which was converted to an open cholecystectomy, and presented with complaints of fever, vomiting, and abdominal pain for 8 days. Angioembolization of the 4.5 mm HAP via a covered stent in the common hepatic artery and computed tomography-guided drainage of a large infected biloma were performed. Persistent bile leak required percutaneous transhepatic biliary drainage (PTBD). After the procedure, the patient's condition improved drastically, and the patient was discharged without complications.

DISCUSSION

IR plays a significant role in the identification and treatment of biliary lesions. IR's key part in dealing with dual complications and suggests a minimally invasive alternative to reoperation. Isolated BDI or HAP has been documented, but the co-occurrence of BDI or HAP is rare, and there is limited literature on IR-based management.

CONCLUSION

The combined use of angioembolization and biliary drainage highlights a minimally invasive and effective approach to avoid the need for further surgical intervention. This case report provides valuable insight into the management of dual complications.