Lower gastrointestinal bleeding due to hepatic artery pseudoaneurysm following laparoscopic cholecystectomy
A 45-year-old male patient presented with pain in right upper quadrant of abdomen. Ultrasound of abdomen showed cholelithiasis and choledocholithiasis for which patient underwent ERCP and stenting with stone extraction. Three weeks later, patient was subjected to LC. Intraoperative course was uneventful except for minor bleeding at Calot's triangle which was successfully cauterized. Early postoperative course was uneventful and patient was discharged on postoperative day 3. After 15 days of discharge, patient presented in the emergency with giddiness and history of haematochezia since 2 days. On examination, he was hypotensive and pale. Per rectal examination showed fresh blood with no local pathology. Ryle's tube aspirate was bilious. Oesophagogastroduodenoscopy did not reveal any evidence of upper GI bleeding. CT angiography suggested active bleeding from a pseudoaneurysm into sub-hepatic space []. Triple-vessel conventional angiography revealed pseudoaneurysm of right hepatic artery []. However, embolisation was not successful due to partial thrombosis at celiac artery origin.\nHence, an emergency laparotomy was contemplated. An actively bleeding right hepatic artery pseudoaneurysm and its fistulous communication with hepatic flexure of the colon were found []. The bleeding aneurysmal vessel was ligated. In view of poor general condition and intraoperative hemodynamic instability, the site of fistulous communication on colon was freshened and brought out as loop colostomy. Postoperative course was uneventful. Patient was discharged on postoperative day 10 and is doing well on follow-up.