Hemobilia after laparoscopic cholecystectomy that was successfully treated conservatively: Case report. (2020)

• Record Type: Journal Article
• Authors: Arata, Ryosuke; Yanagawa, Senichiro; Miyata, Yasushi; Ishitobi, Tomokazu; Kodama, Shinya; Sumimoto, Kazuo
• Is Part Of: International journal of surgery case reports. Volume 77(2020)
• Page Start: 307
• Page End: 310
• Publication Date: 2020
• Subjects: LC laparoscopic cholecystectomy -- CT computed tomography -- CBD common bile duct -- ERCP endoscopic retrograde cholangiopancreatography -- ENBD endoscopic nasobiliary drainage tube -- ERBD endoscopic retrograde biliary drainage; Case report -- Haemobilia -- Laparoscopic cholecystectomy -- Pseudoaneurysm; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.11.015
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Hemobilia from pseudoaneurysm rupture after laparoscopic cholecystectomy is rare. Due to consequent rapid hemodynamic instability, it could be life threatening. Non-contrast CT and ERCP examinations were performed to confirm hemobilia diagnosis. Investigations revealed that there was no contrast agent leakage. Thus, our patient was treated conservatively as opposed to surgically. Abstract: Introduction: Hemobilia due to pseudoaneurysm rupture is a rare, life-threatening complication of laparoscopic cholecystectomy (LC) that can cause rapid hemodynamic instability. Therefore, symptoms of hemobilia must be assessed carefully. Presentation of case: An 88-year-old woman underwent LC in our hospital, and blood tests revealed elevation of hepatobiliary enzyme levels on postoperative day (POD) 12. Computed tomography (CT) showed a high absorption area in the common bile duct (CBD), and a diagnosis of hemobilia and a pseudoaneurysm without active bleeding into the abdominal cavity was made. There was no leakage of contrast medium outside the CBD during endoscopic retrograde cholangiography; thus, an endoscopic nasobiliary drainage (ENBD) tube was inserted on POD 12 and an endoscopic retrograde biliary drainage (ERBD) stent was placed in the CBD on POD 13. Thereafter, hepatobiliary enzyme levels gradually normalized and the ENBD tube and ERBD stent were removed on POD 27 and POD 54, respectively. The patient was discharged on POD 66. Discussion: Hemostasis establishment using surgery or intervention radiology is often required for the treatment of hemobilia due to pseudoaneurysms; however, conservative treatment was effective in our case and we were able to pursue a minimally invasive approach. Erosion due to clip penetration or incomplete clipping of the cystic artery or its branches during surgery may have caused the cystic artery pseudoaneurysm. Conclusion: Hemobilia could be life threatening and cause acute hemodynamic instability; therefore, prompt diagnosis is required. Although the frequency of complication is low, the possibility of hemobilia after LC should be considered.