Cystic artery pseudoaneurysm and haemobilia following laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy has been accepted as the procedure of choice for treating cholelithiasis because of its acceptable complication rate. Haemobilia is a rare and potentially lethal complication that may occur weeks to months after the operation. Case outline: A 52-year-old man who had undergone laparoscopic cholecystectomy was admitted with upper gastrointestinal bleeding and right upper quadrant pain. Emergency gastroduodenoscopy did not identify a source of bleeding. The bleeding ceased, but 11 days after admission he developed haematemesis and obvious jaundice. Results: Endoscopic retrograde cholangiopancreatography (ERCP) showed bulging of the duodenal papilla with spurting of blood. Selective hepatic angiography revealed a pseudo-aneurysm at the cystic artery stump approximately 1 cm in diameter. Transcatheter embolisation of the aneurysm with platinum coils was performed twice with a 21-day interval. The haemobilia was successfully controlled, and he remains well one year later. Discussion: To prevent this kind of complication, it is important to minimise mechanical or thermal injury to the hepatic artery and its branches with meticulous dissection and careful use of electrocautery and metal clips. Selective hepatic angiography can be an important diagnostic and therapeutic modality.