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Hemobilia-a rare complication after laparoscopic cholecystectomy

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Title: Hemobilia-a rare complication after laparoscopic cholecystectomy
Authors: Abiko, Takehiro Browse this author
Ebihara, Yuma Browse this author →KAKEN DB
Takeuchi, Motoya Browse this author
Sakamoto, Hiroki Browse this author
Homma, Hisato Browse this author
Hirano, Satoshi Browse this author →KAKEN DB
Keywords: Double cystic artery
Laparoscopic cholecystectomy
Issue Date: 5-May-2020
Publisher: Springer
Journal Title: Surgical case reports
Volume: 6
Issue: 1
Start Page: 91
Publisher DOI: 10.1186/s40792-020-00837-6
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.
Type: article
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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