Iranian Journal of Surgery

Hepatic Artery Pseudoaneurysm Following Laparoscopic Cholecystectomy: A Rare and Diagnostic-Therapeutic Challenging Case Report

Articles in Press

Document Type : Case Report

Authors

N Malekpour Alamdari 1
M Azimi Aval 2
S. A Salehi 3
M Karimian 4
M Abbasi 5

1 Professor, Department of General Surgery, Critical Care Quality Improvement Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran

2 Assistant Professor, Department of Radiology, AJA University of Medical Sciences, Tehran, Iran

3 Medical Student, Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Assistant Professor, Department of Anesthesiology, Pain and Critical Care, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences Tehran, Iran

5 Assistant Professor, Department of General Surgery, Critical Care Quality Improvement Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences Tehran, Iran

10.22034/ijs.2026.743717
Abstract
Arterial pseudoaneurysm is considered one of the rarest yet potentially most dangerous vascular complications following laparoscopic cholecystectomy, typically developing secondary to direct or indirect injury to the hepatic artery or its branches. In this report, a 45-year-old woman who had undergone laparoscopic cholecystectomy ten days prior presented to the medical center with clinical manifestations of jaundice, abdominal pain, and upper gastrointestinal bleeding.
Imaging evaluations suggested the presence of an arterial pseudoaneurysm originating from the branches of the hepatic artery, accompanied by blood leakage into the biliary system. Based on the findings, the patient underwent diagnostic-therapeutic angiography, and endovascular embolization using coils was successfully performed, leading to the control of the hemorrhage source and stable clinical recovery.
This report emphasizes the importance of considering arterial pseudoaneurysm in patients with a recent history of biliary surgery who present with jaundice, abdominal pain, or gastrointestinal bleeding, as early diagnosis and endovascular interventional treatment can prevent severe complications such as massive hemorrhage, hemorrhagic shock, and death.

Keywords

Hepatic Artery Pseudoaneurysm
Laparoscopic Cholecystectomy
Hemobilia
Biliary Vascular Injury
Endovascular Treatment
1. Babbar A, Gupta V, Sharma D, Jain S, Meena RK, Singh S, et al. Right hepatic artery pseudoaneurysm following laparoscopic cholecystectomy: a rare complication treated with coil embolization. Cureus. 2025;17(7):e89125. doi:10.7759/cureus.89125.
2. Ahmed S, Filep R, Mushtaq A, Budisca O. Right hepatic artery pseudoaneurysm post-laparoscopic cholecystectomy: a case report of endovascular
stent-graft management. Cureus. 2024; 16: e57127. doi:10.7759/cureus.57127.
3. Machado NO, Al Zadjali A, Kakaria AK, Younus S, Rahim MA, Al Sukaiti R. Hepatic or cystic artery pseudoaneurysms following laparoscopic cholecystectomy: literature review of aetiopathogenesis, presentation, diagnosis, and management. Sultan Qaboos Univ Med J. 2017; 17: e135-e146. doi:10.18295/squmj.2016.17.02.002.
4. Strasberg SM, Helton WS. An analytical review of vasculobiliary injury in laparoscopic and open cholecystectomy. HPB (Oxford). 2011; 13: 1–14. doi:10.1111/j.1477-2574.2010.00225.x.
5. Connor S, Garden OJ. Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg. 2006; 93: 158-68.
6. Finley DS, Hinojosa MW, Paya M, Imagawa DK. Hepatic artery pseudoaneurysm: a report of seven cases and a review of the literature. Surg Today. 2005; 35:543-7.
7. Merrell SW, Schneider PD. Hemobilia-evolution of current diagnosis and treatment. West J Med. 1991; 155: 621-5.
8. Raza M, Hakeem A, Sheikh M, et al. Vascular complications after laparoscopic cholecystectomy: a systematic review. Ann Hepatobiliary Pancreat Surg. 2016; 20: 1-8.
9. Tessier DJ, Stone WM, Fowl RJ, et al. Visceral artery aneurysms: a retrospective review of 38 cases. Ann Vasc Surg. 2003; 17: 35-45.
10.    Saad WE, Davies MG, Sahler L, et al. Visceral artery pseudoaneurysms: management with endovascular techniques. J Vasc Interv Radiol. 2005; 16:671-82.
11.    Venturini M, Marra P, Colombo M, et al. Endovascular treatment of visceral artery aneurysms and pseudoaneurysms: results and long term follow up. Cardiovasc Intervent Radiol. 2018; 41:
1369-76.
12.    de Perrot M, Berney T, Bühler L, et al. Management of true aneurysms and pseudoaneurysms of the hepatic artery. Ann Surg. 1999; 229:
416-23.
13.    Barrionuevo P, Malas MB, Nejim B, et al. A systematic review and meta analysis of the management of visceral artery aneurysms. J Vasc Surg. 2019; 70: 1694-709.e4.
14.    Chadha M, Ahuja C. Visceral artery aneurysms: diagnosis and percutaneous management. Semin Intervent Radiol. 2009; 26: 196-206.
15.    Machado NO, Al Zadjali A, Kakaria AK, et al. Hepatic or cystic artery pseudoaneurysms following laparoscopic cholecystectomy: review of aetiopathogenesis, presentation, diagnosis and management. Sultan Qaboos Univ Med J. 2017; 17: e135-46.
16.    Ahmed Z, Siddiqui WJ, Malik F, et al. Right hepatic artery pseudoaneurysm after laparoscopic cholecystectomy managed with endovascular stent graft: a case report. Cureus. 2024; 16: e57127.
17.    Tulsyan N, Kashyap VS, Greenberg RK, et al. The endovascular management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg. 2007; 45: 276-83.
18.    Venturini M, Loffroy R, Marra P, et al. Transcatheter embolization of visceral artery pseudoaneurysms: when and how? Radiographics. 2020; 40:1131-48.
19.    Cheung H, Chan YC, Cheng SWK, et al. Iatrogenic hepatic artery pseudoaneurysm after biliary surgery: diagnosis and endovascular management. Ann Vasc Surg. 2025; 88: 284-91.
Iranian Journal of Surgery

Articles in Press, Accepted Manuscript
Available Online from 07 November 2026

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