scholarly journals Management of a pseudo-aneurysm in the hepatic artery after a laparoscopic cholecystectomy

2016 ◽  
Vol 98 (7) ◽  
pp. 456-460 ◽  
Author(s):  
MP Senthilkumar ◽  
N Battula ◽  
MTPR Perera ◽  
R Marudanayagam ◽  
J Isaac ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Laparoscopic Cholecystectomy ◽  
Hepatic Artery ◽  
Computed Tomography Angiography ◽  
Rare Complication ◽  
Artery Pseudoaneurysm ◽  
Pseudo Aneurysm ◽  
High Index Of Suspicion ◽  
Time Of Presentation

Introduction Symptomatic hepatic-artery pseudoaneurysm (HAP) after bile-duct injury (BDI) is a rare complication with a varied (but clinically urgent) presentation. Methods A prospectively maintained database of all patients with BDI at laparoscopic cholecystectomy (LC) referred to a tertiary specialist hepatobiliary centre between 1992 and 2011 was searched systematically to identify patients with a symptomatic HAP. Care and outcome of these patients was studied. Results Eight (6 men) of 236 patients with BDI (3.4%) with a median age of 65 (range: 54?6) years presented with symptomatic HAP. Median time of presentation of the HAP from the index LC was 31 (range: 13?16) days. Bleeding was the dominant presentation in 7 patients. One patient presented late (>2 years) with abdominal pain alone. Computed tomography angiography was the most useful investigation. Angioembolisation was successful in 7 patients. One patient died, and another patient developed liver infarction. Three patients (38%) developed biliary strictures after embolisation. Seven patients are alive and well at a median follow-up of 66 months. Conclusions Presentation of HAP is often delayed. A high index of suspicion is necessary for the diagnosis. Computed tomography angiography is the first-line investigation and selective angioembolisation can yield successful outcomes.

scholarly journals Endovascular Repair of a Common Carotid Pseudoaneurysm in a Patient with Behçet’s Disease: A Case Report and Review of Literature

2020 ◽  
Author(s):  
Seyed Ebrahim Kassaian ◽  
Behnam Molavi ◽  
Kyomars Abbasi ◽  
Mohammad Sadeghian ◽  
Shahrooz Yazdani
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Behçet’S Disease ◽  
Endovascular Repair ◽  
Computed Tomography Angiography ◽  
Behcet’S Disease ◽  
Behçet's Disease ◽  
Artery Pseudoaneurysm ◽  
Behcet's Disease

Behçet’s disease (BD) is a multisystem inflammatory disorder. Physicians should be alerted to the possibility of BD in a patient with a carotid artery pseudoaneurysm and no clear predisposing factor such as neck trauma or surgery. Endovascular repair of carotid pseudoaneurysms is technically feasible with excellent midterm follow-up results. Administration of immunosuppressive therapy before endovascular intervention is mandatory to reduce the chance of vascular complications accompanied by BD. A 40-year-old man presented with a painful and pulsatile neck mass with 2 episodes of transient ischemic attacks. The patient also complained of recurrent urogenital ulcers and aphthous lesions together with painful rashes. Ultrasonography and computed tomography angiography revealed 2 aneurysmal dilations in the left common carotid artery at the bifurcation level. He was referred to a rheumatologist, who made the diagnosis of BD. High-dose corticosteroids and cyclophosphamide were commenced. One week later, 2 overlapping self-expanding stent grafts were deployed. The final angiogram showed no residual endoleak, and the flow of the carotid and cerebral arteries was satisfactory. The patient was discharged with no neurological complications. Follow-up ultrasonography and computed tomography angiography 6 months later showed no endoleak, as well as significant shrinkage of the aneurysm sac.

scholarly journals Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Kurniawan Kurniawan ◽  
I Dewa Nyoman Wibawa ◽  
Gde Somayana ◽  
I Ketut Mariadi ◽  
I Made Mulyawan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gastrointestinal Bleeding ◽  
Abdominal Trauma ◽  
Upper Gastrointestinal Bleeding ◽  
Rare Complication ◽  
Gastroduodenal Artery ◽  
Time Interval ◽  
Artery Pseudoaneurysm ◽  
History Of ◽  
Upper Gastrointestinal

Abstract Background Hemobilia is a rare cause of upper gastrointestinal bleeding that originates from the biliary tract. It is infrequently considered in diagnosis, especially in the absence of abdominal trauma or history of hepatopancreatobiliary procedure, such as cholecystectomy, which can cause arterial pseudoaneurysm. Prompt diagnosis is crucial because its management strategy is distinct from other types of upper gastrointestinal bleeding. Here, we present a case of massive hemobilia caused by the rupture of a gastroduodenal artery pseudoaneurysm in a patient with a history of laparoscopic cholecystectomy 3 years prior to presentation. Case presentation A 44-year-old Indonesian female presented to the emergency department with complaint of hematemesis and melena accompanied by abdominal pain and icterus. History of an abdominal trauma was denied. However, she reported having undergone a laparoscopic cholecystectomy 3 years prior to presentation. On physical examination, we found anemic conjunctiva and icteric sclera. Nonvariceal bleeding was suspected, but esophagogastroduodenoscopy showed a blood clot at the ampulla of Vater. Angiography showed contrast extravasation from a gastroduodenal artery pseudoaneurysm. The patient underwent pseudoaneurysm ligation and excision surgery to stop the bleeding. After surgery, the patient’s vital signs were stable, and there was no sign of rebleeding. Conclusion Gastroduodenal artery pseudoaneurysm is a rare complication of laparoscopic cholecystectomy. The prolonged time interval, as compared with other postcholecystectomy hemobilia cases, resulted in hemobilia not being considered as an etiology of the gastrointestinal bleeding at presentation. Hemobilia should be considered as a possible etiology of gastrointestinal bleeding in patients with history of cholecystectomy, regardless of the time interval between the invasive procedure and onset of bleeding.

Multi-detector computed tomography angiography of the hepatic artery in liver transplant recipients

2005 ◽  
Vol 46 (5) ◽  
pp. 455-461 ◽  
Author(s):  
P. Boraschi ◽  
F. Donati ◽  
M. C. Cossu ◽  
R. Gigoni ◽  
C. Vignali ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Liver Transplant ◽  
Hepatic Artery ◽  
Volume Rendering ◽  
Computed Tomography Angiography ◽  
Invasive Technique ◽  
Reconstruction Technique ◽  
Oral Contrast ◽  
Transplant Recipients ◽  
Liver Transplant Recipients

Purpose: To evaluate the ability of multi-detector row computed tomography angiography (CTA) in detecting hepatic artery complications in the follow-up of liver transplant patients, performing volume-rendering as reconstruction technique. Material and Methods: The anatomy of hepatic artery was studied in 27 liver transplant recipients with a four-row CT scanner using the following parameters: collimation, 1 mm; slice width, 1 mm; table feed, 6–8 mm/s; spiral reconstruction time, 0.5 s; reconstruction interval, 0.5 mm; mAs, 160; kVp, 120. Before the study, the patients received 1000 ml of water as oral contrast agent to produce negative contrast in the stomach and the small bowel. A non-ionic contrast medium was infused intravenously at a rate of 5 ml/s with a bolus tracking system. Volume-rendering of hepatic artery was performed with the 3D Virtuoso software. Results: The celiac trunk, the hepatic artery, and the right and left hepatic arteries were successfully displayed in high detail in all patients. Side branches, including small collaterals, and hepatic artery anastomosis could also be readily visualized. Volume-rendered CTA detected six hepatic artery stenoses, two hepatic artery thromboses, and two intrahepatic pseudoaneurysms. In two cases, CT detected hepatic artery stenosis with a diameter reduction of less than 50%, while digital subtraction angiography showed a normal artery. Conclusion: Volume-rendered multi-detector CTA is a promising non-invasive technique, since it allows images of high quality to be generated with excellent anatomical visualization of the hepatic artery and its complications in liver transplant recipients.

scholarly journals Imaging techniques in the assessment of endovascular infrarenal abdominal aortic repair

2020 ◽  
Vol 73 (1-2) ◽  
pp. 29-35
Author(s):  
Aleksandar Spasic ◽  
Viktor Till ◽  
Marijana Basta-Nikolic ◽  
Djordje Milosevic ◽  
Darka Hadnadjev-Simonji ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Imaging Techniques ◽  
First Year ◽  
Imaging Method ◽  
Diagnostic Modality ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Enhanced Computed Tomography

Introduction. Imaging is essential in the assessment of endovascular infrarenal abdominal aortic repair results. Complications include endoleaks, graft migration, kinking and infolding, stenosis, occlusion, and secondary ruptures. Examination Modalities. Contemporary imaging strategies are based on using noninvasive imaging modalities. After endovascular infrarenal abdominal aortic repair, the standard evaluation modality is computed tomography angiography, whereas additional modalities include magnetic resonance imaging, ultrasonography, and radiography. However, although an invasive imaging method, digital subtraction angiography is still performed in some patients. Computed tomography angiography provides excellent contrast, spatial resolution, and exact measurements of structures of interest, which is essential in the follow-up. Follow-up Protocol. Currently recommended follow-up protocol in the first year is contrast- enhanced computed tomography imaging at 1 and 12 months after the procedure. Conclusion. Due to its characteristics, reproducibility and availability, computed tomography angiography remains the cornerstone diagnostic modality of post-procedural assessment in patients with endovascular infrarenal abdominal aortic repair.

scholarly journals Retracted: Diagnostic Dilemma of a Diaphragmatic Hernia

2018 ◽  
Vol 4 (3) ◽  
Author(s):  
Salman Yahya ◽  
Sonia Zafar ◽  
Hafsa S. Babar
Keyword(s):  
Diaphragmatic Hernia ◽  
Turning Point ◽  
Rare Complication ◽  
Young Male ◽  
Acute Ischemia ◽  
Radiological Findings ◽  
Diagnostic Dilemma ◽  
High Index Of Suspicion ◽  
Disease Free

Diaphragmatic hernia post esophagectomy is a rare complication but a reality in its existence. It is typically difficult to diagnose but highly depends on keeping high index of suspicion. In our case report, the young male who underwent esophagectomy for esophageal carcinoma, remained disease free and stable in his 9 months follow up, suddenly presented in the emergency department with the symptoms of shortness of breath, chest pain, vomiting and tachycardia. The case was typically complicated by the initial treatment given for acute ischemia and cardiogenic shock. Radiological findings proved to be helpful and turning point in the diagnosis and overall management.

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