We report a case of severe hemobilia due to a Right Hepatic Artery Pseudoaneurysm (RHAP) occurring 4 months after a laparoscopic converted to open cholecystectomy. The abdominal CT, ultrasound and an endoscopic retrograde cholangio pancreatography strongly suggested a RHAP. Our patient underwent a new open laparotomy; however, active bleeding recurred. The patient became hemodynamically unstable and received several globular units to avoid hypovolemic shock. A celiac trunk angiography confirmed a RHAP. Using a coaxial technique, geometry guided microcatheter reached a stable position in close proximity to the RHAP and an embolic mixture of n-butyl cyanoacrylate dissolved in lipiodol was injected achieving a successful deconstructive obliteration of both RHAP and RHA. Our patient made an uneventful and rapid recovery.
Date |
15/08 |
18/08 |
25/08 |
Hemoglobin (g/dL) |
3.7 |
10.4 |
10.0 |
MCV / mch (fl / pg) |
83/26 |
85/29 |
92/30 |
Leucocytes (cEl/ul) |
4.41 |
11.09 |
9.6 |
RODS |
0 |
0 |
|
Segmented |
54 |
67 |
|
Platelets x 103 (cél/ul) |
269 |
190 |
312 |
Inr |
1.15 |
1.08 |
|
TTPa (sec) |
30.9 |
||
Urea / creatinine (mg/dl) |
45/0.6 |
25.9/ |
|
Proteins / albumin (g/dl) |
5.3/2.7 |
4.8/2.3 |
6.6 |
Bilirubin tot / dir (mg/dl) |
2.1/1.5 |
5.0/3.9 |
0.8/0.7 |
got / pgt (ui/l) |
218/124 |
49/72 |
32/34 |
Alkaline Phosphatase / ggtp (ui/l) |
467/440 |
215/224 |
252/162 |
Citation: Canales R, del Castillo M, García-Encinas C, Plasencia A, Sierralta D, et al. (2018) Transarterial Embolization of a Hepatic Pseudoaneurysm with Hemobilia. J Angiol Vasc Surg 3: 012.
Copyright: © 2018 Canales Rosa, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.