Hemobilia-a rare complication after laparoscopic cholecystectomy-
Abstract Background Biliary bleeding is a condition reported by Sandblom as hemobilia. The most common cause of hemobilia is iatrogenicity. But it has also been reported as a rare complication after laparoscopic cholecystectomy (LC). Case presentation A man in his 60s underwent a LC. He was taking a...
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Japan Surgical Society
2020-05-01
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| Series: | Surgical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40792-020-00837-6 |
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| author | Takehiro Abiko Yuma Ebihara Motoya Takeuchi Hiroki Sakamoto Hisato Homma Satoshi Hirano |
| author_facet | Takehiro Abiko Yuma Ebihara Motoya Takeuchi Hiroki Sakamoto Hisato Homma Satoshi Hirano |
| author_sort | Takehiro Abiko |
| collection | DOAJ |
| description | Abstract Background Biliary bleeding is a condition reported by Sandblom as hemobilia. The most common cause of hemobilia is iatrogenicity. But it has also been reported as a rare complication after laparoscopic cholecystectomy (LC). Case presentation A man in his 60s underwent a LC. He was taking a direct Xa inhibitor for paroxysmal atrial fibrillation (pAf) and had a history of thrombectomy. There was variation in the bifurcation of the hepatic artery and cystic artery. The right hepatic artery branches from the common hepatic artery by itself, and the cystic artery is double. He complained of right upper quadrant pain, nausea, and vomiting on the third postoperative day (3POD). Non-contrast computed tomography (CT) showed that a high absorption area was found to fill the common bile duct. Contrast CT showed no pseudoaneurysm formation. Ultimately, he was diagnosed with postoperative hemobilia. Angiographic examination selective for the cystic artery branching from the middle hepatic artery revealed leakage of the contrast agent and a micro-pseudoaneurysm. Conclusions We encountered a case of hemobilia after LC. In this case, it was presumed that in addition to the chronic inflammatory changes of the gallbladder wall, extraordinary bifurcation of the hepatic artery and the cystic arteries and easy bleeding due to resumption of a direct Xa inhibitor synergistically caused a micro-pseudoaneurysm and postoperative hemobilia. It was difficult to identify the cause of hemobilia by contrast CT alone. Angiographic examination was useful for identifying and treating the causative artery and needs to perform aggressively. |
| format | Article |
| id | doaj-art-a235c44a74af470ab9f702c7ef9da149 |
| institution | Kabale University |
| issn | 2198-7793 |
| language | English |
| publishDate | 2020-05-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-a235c44a74af470ab9f702c7ef9da1492025-08-20T03:56:59ZengJapan Surgical SocietySurgical Case Reports2198-77932020-05-01611610.1186/s40792-020-00837-6Hemobilia-a rare complication after laparoscopic cholecystectomy-Takehiro Abiko0Yuma Ebihara1Motoya Takeuchi2Hiroki Sakamoto3Hisato Homma4Satoshi Hirano5Gastroenterological Surgery, Sapporo Kyoritsu Gorinbashi HospitalDepartment of Gastroenterological Surgery II, Hokkaido University Faculty of MedicineGastroenterological Surgery, Sapporo Kyoritsu Gorinbashi HospitalGastroenterology, Sapporo Kyoritsu Gorinbashi HospitalGastroenterology, Sapporo Kyoritsu Gorinbashi HospitalDepartment of Gastroenterological Surgery II, Hokkaido University Faculty of MedicineAbstract Background Biliary bleeding is a condition reported by Sandblom as hemobilia. The most common cause of hemobilia is iatrogenicity. But it has also been reported as a rare complication after laparoscopic cholecystectomy (LC). Case presentation A man in his 60s underwent a LC. He was taking a direct Xa inhibitor for paroxysmal atrial fibrillation (pAf) and had a history of thrombectomy. There was variation in the bifurcation of the hepatic artery and cystic artery. The right hepatic artery branches from the common hepatic artery by itself, and the cystic artery is double. He complained of right upper quadrant pain, nausea, and vomiting on the third postoperative day (3POD). Non-contrast computed tomography (CT) showed that a high absorption area was found to fill the common bile duct. Contrast CT showed no pseudoaneurysm formation. Ultimately, he was diagnosed with postoperative hemobilia. Angiographic examination selective for the cystic artery branching from the middle hepatic artery revealed leakage of the contrast agent and a micro-pseudoaneurysm. Conclusions We encountered a case of hemobilia after LC. In this case, it was presumed that in addition to the chronic inflammatory changes of the gallbladder wall, extraordinary bifurcation of the hepatic artery and the cystic arteries and easy bleeding due to resumption of a direct Xa inhibitor synergistically caused a micro-pseudoaneurysm and postoperative hemobilia. It was difficult to identify the cause of hemobilia by contrast CT alone. Angiographic examination was useful for identifying and treating the causative artery and needs to perform aggressively.http://link.springer.com/article/10.1186/s40792-020-00837-6Double cystic arteryHemobiliaLaparoscopic cholecystectomy |
| spellingShingle | Takehiro Abiko Yuma Ebihara Motoya Takeuchi Hiroki Sakamoto Hisato Homma Satoshi Hirano Hemobilia-a rare complication after laparoscopic cholecystectomy- Surgical Case Reports Double cystic artery Hemobilia Laparoscopic cholecystectomy |
| title | Hemobilia-a rare complication after laparoscopic cholecystectomy- |
| title_full | Hemobilia-a rare complication after laparoscopic cholecystectomy- |
| title_fullStr | Hemobilia-a rare complication after laparoscopic cholecystectomy- |
| title_full_unstemmed | Hemobilia-a rare complication after laparoscopic cholecystectomy- |
| title_short | Hemobilia-a rare complication after laparoscopic cholecystectomy- |
| title_sort | hemobilia a rare complication after laparoscopic cholecystectomy |
| topic | Double cystic artery Hemobilia Laparoscopic cholecystectomy |
| url | http://link.springer.com/article/10.1186/s40792-020-00837-6 |
| work_keys_str_mv | AT takehiroabiko hemobiliaararecomplicationafterlaparoscopiccholecystectomy AT yumaebihara hemobiliaararecomplicationafterlaparoscopiccholecystectomy AT motoyatakeuchi hemobiliaararecomplicationafterlaparoscopiccholecystectomy AT hirokisakamoto hemobiliaararecomplicationafterlaparoscopiccholecystectomy AT hisatohomma hemobiliaararecomplicationafterlaparoscopiccholecystectomy AT satoshihirano hemobiliaararecomplicationafterlaparoscopiccholecystectomy |