Massive Upper Gastrointestinal Bleeding; A Rare Manifestation of Complications of Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the standard treatment for gallbladder diseases. Hepatic artery pseudoaneurysm is a rare complication of bile duct injury. Rupture is accompanied by abdominal pain, intraperitoneal bleeding, jaundice, and gastrointestinal bleeding (GIB). In this study, we introduce a patient who underwent laparoscopic cholecystectomy. During the laparoscopic operation the patient needed open surgery due to bleeding; and a month later, the patient presented with massive upper gastrointestinal bleeding.

The patient was a 43-year-old woman with a history of laparoscopic cholecystectomy one month before. She presented with complaints of abdominal pain and hematemesis. Gastrointestinal endoscopy showed duodenal bulb erosion, and computed tomography (CT) scan showed evidence in favor of hepatic artery pseudoaneurysm. The patient underwent emergency laparotomy due to hemorrhagic shock. Hematoma and pseudoaneurysm of the right hepatic artery from superior mesenteric artery were seen in the exploration. The exploration of subhepatic hematoma, hepatic artery repair, and abdominal cavity drainage was done. A few days after the operation, the patient was discharged in good general condition, stable vital sign, normal laboratory tests, and PO tolerance. There was no complication in one month follow-up.

Vascular injuries are rare complications in patients undergoing cholecystectomy, and its manifestation as UGIB is very rare. Due to its high morbidity and mortality, it should be evaluated and treated as soon as possible.