HEMOBILIA COMPLICATING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY - A CASE-REPORT

Iatrogenic injury to the hepatic or cystic arteries can occur during l aparoscopic cholecystectomy and can be seen in isolation or in associa tion with bile-duct injury. The most common manifestation of arterial injury is intraoperative hemorrhage; also, interruption of the right h epatis artery can occur without hemmorrhage, and this can be clinicall y insignificant or associated with hepatic ischemia. A less common man ifestation of arterial injury during laparoscopic cholecystectomy is p resented. A 48-year-old woman had a pseudoaneurysm of the major anteri or branch of the right hepatic artery in association with an injury to the common hepatic duct. This complication presented as massive hemob ilia after she had been discharged from the hospital. Definitive repai r of the pseudoaneurysm was carried out at the time of Roux-en-Y hepat icojejunostomy for correction of the associated duct injury. This unus ual vascular complication should be considered in patients after lapar oscopic cholecystectomy who demonstrate evidence of late occult or obv ious hemorrhage.