Hepatic artery pseudoaneurysm with hemobilia following angioplasty after liver transplantation

A 58-yr-old female with primary biliary cirrhosis underwent an uncomplicate d orthotopic liver transplantation. Elevated liver function tests 2 months post-transplantation were evaluated with Doppler ultrasound and a hepatic a rtery stricture was documented. The hepatic artery stenosis was treated wit h angioplasty. She developed hemobilia 1 d after the procedure, which was c onfirmed by angiography. Emergent exploratory laparotomy revealed a pseudoa neurysm at the hepatic artery anastomosis. The pseudoaneurysm was resected and the proper hepatic artery of the graft was anastomosed to the splenic a rtery of the host using preserved homograft. Her post-operative course was uneventful and liver function tests returned to normal quickly after the su rgery. This report will discuss the unusual nature of this complication, an d review the problem of hemobilia and pseudoaneurysms in liver transplant r ecipients.