Right hepatic artery pseudoaneurysm after choledocoduodenostomy: a case report

Abstract

Background: Pseudoaneurysm of right hepatic artery is a rare complication after bile duct injury (BDI) repair. An unidentified rupture of pseudoanuerysm will lead to mismanagement of this fatal complication. Massive haemorrhage can present and causes high mortalityCase Description: We report a 60-year-old female who suffered jaundice and massive upper gastrointestinal bleeding two weeks after cholodocoduodenostomy bypass surgery in rural hospital. That procedure was done because of BDI after laparoscopic cholecystectomy. Embolisation was carried out after identifying an pseudoaneurysm of right hepatic artery to stop bleeding. Bleeding was transiently stopped, and rebleeding occurred several weeks later. Surgery was performed because of repeated bleeding after third embolization in Kariadi hospital. Ruptured pseudoaneurysm to choledocoduodenostomy anastomosis was found. Pseudoaneurysm was resected and right hepatic artery was sutured. Choledocoduodenostomy was closed. Continuity of biliary tract was maintained by re-reconstruction choledoco-jejunostomy roux n Y. Upper gastrointestinal bleeding symptom was disappeared, and bilirubin level was returned to normal at outpatient follow up after operation.Conclusion: This patient had a hemobilia because of ruptured right hepatic artery pseudoaneurysm. Triad Quincke which consist of right upper quadrant pain, jaundice and upper gastrointestinal bleeding, occurs in 30% of patient with hemobilia. This sign of hemobilia after biliary tract procedure must be managed quickly and accurately. Angiography is main diagnostic procedure. Arterial embolisation is first line intervention to stop the bleeding. Surgery is preserved in case where rebleeding occurs. Good anatomical knowledge can prevent this complication.