Presentation
Abdominal pain and jaundice after cholecystectomy.
Patient Data
A well-defined oval-shaped intensely enhancing lesion is noted at the porta hepatis. It follows the arterial density in the arterial, venous and delayed phases in keeping with an arterial lesion. In the context of preceding surgery to the region, the diagnosis of hepatic artery pseudoaneurysm is established. No signs of rupture, no free fluid.
Thick-walled subhepatic fluid collection with internal debris associated with few gas locules seen at the non-dependent portion in keeping with infected subhepatic collection (abscess).
Aberrant origin of common hepatic artery from the SMA rather than from celiac trunk.
Mildly dilated intrahepatic bile ducts.
Cholecystectomy clips and drain are also visualized.
The arrows point toward the hepatic artery pseudoaneurysm and clearly show the aberrant origin of the common hepatic artery from SMA rather than from the celiac trunk.
DSA shows the right hepatic artery aneurysm pre-embolization and total disappearance after the procedure by using Histoacryl as an embolization material.
Case Discussion
The case demonstrates a rare, potentially fatal complication of cholecystectomy, that is iatrogenic hepatic artery pseudoaneurysm, which occurred in this patient after a laparoscopic approach that converted to open surgery after recognizing the complication during surgery. Note the variant anatomy of common hepatic artery origin.
The interventional radiologist was consulted and the condition treated successfully by using Histoacryl.
Regarding the subhepatic collection, the patient was lost to follow-up.
Case courtesy of Prof Mohammed A Al-jiboori, consultant radiologist, and Dr Mustafa Al-khassaf, interventional radiologist.
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