1/72. Successful treatment of a pseudoaneurysm of the cystic artery with microcoil embolization.Pseudoaneurysms of visceral arteries are uncommon but well-characterized vascular abnormalities, usually provoked by intraabdominal inflammatory processes such as pancreatitis or cholecystitis, or by surgical trauma. However, pseudoaneurysms of the cystic artery are rare. They complicate cholecystitis or cholecystectomy, and manifest as hemobilia as they rupture into the biliary tree. The advent of transcatheter embolization techniques has begun to allow minimally invasive treatment of these life-threatening complications. Transcatheter embolization can be performed using several types of material, such as synthetic occlusive emulsions, gelatin sponges or other particles, or metallic microcoils. Microcoils are small metallic helical particles, made of stainless-steel, platinum, or tungsten. Super-selective catheterization of an artery and release of microcoils causes the vessel to thrombose and allows control of bleeding.- - - - - - - - - - ranking = 1keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
2/72. Laparoscopic cholecystectomy and the Peter Pan syndrome.We report the case of a patient who experienced hemobilia a few weeks after undergoing laparoscopic cholecystectomy (LC). This condition was due to the rupture of a pseudo-aneurysm of the right hepatic artery in the common bile duct, probably caused by a clip erroneously fired during LC on the lateral right wall of the vessel. It also caused the formation of multiple liver abscesses and the onset of sepsis. This life-threatening complication led to melena, fever, epigastric pain, pancreatitis, liver dysfunction, and severe anemia, requiring urgent hospitalization and operation. In the operating theater, the fistula was closed, the liver abscesses drained, and a Kehr tube inserted. Thereafter, the patient's general condition improved, and she is now well. LC is often considered to be the gold standard for the management of symptomatic cholelithiasis. However, recent data have undermined that opinion. The apparent advantages offered by LC in the short term (less pain, speedier recovery, shorter hospital stay, and lower costs) have been overwhelmed by the complications that occur during long-term follow-up. When the late downward trend in the bile duct and the vascular injury rate are taken into consideration, the learning curve is prolonged. Therefore, LC should be regarded as the surgical equivalent of a modern Peter Pan-i.e., it is like a young adult who should make definitive steps toward becoming an adult but does not succeed in doing so. We report the case of a patient who experienced hemobilia a few weeks after undergoing laparoscopic cholecystectomy. Based on the facts in this case, we argue that the endoscopic procedure still needs to be perfected and cannot yet be considered the gold standard for selected cases of gallstone disease.- - - - - - - - - - ranking = 0.0056327059198375keywords = aneurysm (Clic here for more details about this article) |
3/72. hemobilia: four case reports and review of the literature.In this report, we present four cases of hemobilia. hemobilia occurs when conditions produce an abnormal communication between blood vessels and bile ducts. Although iatrogenic procedures as causes of hemobilia have been reported with increasing frequency, non-iatrogenic etiologies are still quite rare. We, therefore, report 4 cases of hemobilia secondary to different etiologies found in our institution from 1996 to 1998, that are non-iatrogenic. The first patient was a case of congenital aneurysm, the second pseudoaneurysm from trauma, the third cholangiocarcinoma and the fourth hepatocellular carcinoma. The classical triad consists of melena, jaundice and abdominal pain. Direct observation of blood flowing from the ampulla of vater by endoscopy was the initial diagnostic procedure in all four cases. diagnosis was confirmed by ultrasonography, computerized tomography, angiography or surgery. Transcatheter selective embolization as a noninvasive treatment for hepatic aneurysm/pseudoaneurysm is emphasized.- - - - - - - - - - ranking = 0.40901232947174keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
4/72. Pseudoaneurysm of gastroduodenal artery associated with mitral valve prolapse presenting as haemobilia.Pseudoaneurysms of the hepatic or gastroduodenal arteries may cause Haemobilia. mitral valve prolapse associated with mycotic pseudoaneurysm of cerebral and extracerebral arteries have been reported. We report a case of gastroduodenal artery pseudoaneurysm presenting as haemobilia. The patient was successfully treated with indigenously fabricated steel coil embolization followed by surgery.- - - - - - - - - - ranking = 0.42591044723125keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
5/72. A case of amebic liver abscess complicated by hemobilia due to rupture of hepatic artery aneurysm.We report the case of a 51-year-old man with hepatic amebic abscess complicated by hepatic artery aneurysm. The patient first presented with peritonitis caused by perforating appendicitis. Surgical treatment resolved peritonitis but entamoeba histolytica was detected in the colonic mucosa. Subsequently, liver abscess developed and the size of the abscess increased gradually after surgery in spite of continued treatment with metronidazole. Brown pus was drained from the abscess but 13 days after the drainage process the patient complained of right upper abdominal pain and the drained fluid became blood-colored and stool became tarry in color. Enhanced computed tomography showed a hepatic artery aneurysm that had ruptured into the liver abscess and duodenoscopy revealed bleeding from the ampulla of vater. Transcatheter arterial embolization with several steel coils was successfully performed which resulted in cessation of bleeding from the ampulla of vater. The patient was discharged without any complications five weeks after rupture of the aneurysm. Our case demonstrates rupture of the hepatic artery aneurysm as a rare complication of amebic liver abscess and the effectiveness of interventional embolotherapy in this condition.- - - - - - - - - - ranking = 0.0450616473587keywords = aneurysm (Clic here for more details about this article) |
6/72. Management of hemobilia with transarterial angiographic embolization: report of one case.A nine-year-old girl who developed life threatening hemobilia after blunt abdominal trauma was successfully managed by embolization of the hepatic artery aneurysm. However, biliary fistula persisted and subcapsular liver abscess occurred after the endoscopic sphincterotomy and the placement of a nasobiliary drain for bile leakage. debridement of the abscess and insertion of a drain tube eventually cured the event. The relevant literature is reviewed and the management of the hemobilia is discussed.- - - - - - - - - - ranking = 0.0056327059198375keywords = aneurysm (Clic here for more details about this article) |
7/72. Guglielmi detachable coil erosion into the common bile duct after embolization of iatrogenic hepatic artery pseudoaneurysm.Intermittent hemobilia with a hepatic artery pseudoaneurysm can be seen after open or laparoscopic cholecystectomy. Transcatheter treatment of this complication is widely accepted. Although some authors suggest packing the pseudoaneurysm with coils as the treatment of choice, occluding the parent artery is the standard treatment. The authors present an unusual complication of Guglielmi detachable coil erosion into the common bile duct in a patient who presented with pancreatitis 2 years after undergoing packing of the hepatic artery pseudoaneurysm with coils. The probable causes of this rare outcome and alternative treatment options are discussed.- - - - - - - - - - ranking = 1.3921142117122keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
8/72. Post cholecystectomy hemobilia: transcatheter embolization of pseudoaneurysms with homemade steel coils.Two patients presented with hemobilia, one and two months following cholecystectomy. angiography demonstrated pseudoaneurysms arising form the gastroduodenal and right hepatic arteries. Percutaneous transcatheter embolization of the pseudoaneurysms was successfully performed in both patients using homemade steel coils.- - - - - - - - - - ranking = 1.1932407528962keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
9/72. Pseudoaneurysm of the cystic artery with hemobilia treated by arterial embolization and elective cholecystectomy.Pseudoaneurysm of the cystic artery is a rare cause of hemobilia, with only 11 cases having been reported in the English literature. We report this unusual condition in a 62-year-old Japanese man whose chief complaint was repeated upper abdominal pain. A liver function test showed obstructive jaundice, and endoscopy revealed a small amount of blood coming from the papilla of Vater. We diagnosed him as having hemobilia, and immediate angiography was performed. The results demonstrated a pseudoaneurysm arising in the cystic artery. Selective embolization of the cystic artery then followed. Ten days later the patient underwent elective cholecystectomy and had a good postoperative course. Microscopically, the resected specimen revealed caliculous cholecystitis and an organized pseudoaneurysm perforating the lumen of the gallbladder. We supposed that this pseudoaneurysm was associated with the inflammatory reaction seen with the acute cholecystitis. This case emphasizes the need for a high level of awareness of hemobilia whenever bleeding is associated with signs of biliary disorders. Immediate angiography and embolization of the pseudoaneurysm followed by radical surgery may be the preferred strategy. We believe this is the first reported case of successful "two-step" treatment of such a pseudoaneurysm.- - - - - - - - - - ranking = 1.0225308236793keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
10/72. hemobilia in a patient with multiple intrahepatic, hepatic artery aneurysms.hemobilia is a rare form of upper gastrointestinal system (GIS) bleeding. rupture of the hepatic artery aneurysm into the biliary tract is also an uncommon cause of hemobilia. We report a case of hemobilia, secondary to rupture of one of multiple aneurysms of both right and left hepatic arteries. It was treated by hepatic artery ligation.- - - - - - - - - - ranking = 0.033796235519025keywords = aneurysm (Clic here for more details about this article) |
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