# Surgical Treatment of Pseudoaneurysm of the Right Hepatic Artery Following Cholecystectomy: A Case Report

## TL;DR

A patient developed a pseudoaneurysm of the right hepatic artery after cholecystectomy and required surgical treatment due to unavailability of embolization.

## Contribution

This case report highlights the rare complication of right hepatic artery pseudoaneurysm and the surgical management when embolization is not available.

## Key findings

- Surgical resection and ligation of the pseudoaneurysm was performed due to hemodynamic instability.
- MRI confirmed the presence of a large hematoma and pseudoaneurysm post-cholecystectomy.
- Embolization unavailability necessitated surgical intervention as the primary treatment.

## Abstract

Pseudoaneurysms of the right hepatic artery following cholecystectomy are caused by either vascular damage or erosion after a biliary leak. Symptoms often include haemobilia, melena, vomiting, jaundice, and hemodynamic failure due to aneurysm rupture. The ideal treatment is arterial embolization or, in rare cases, stenting.

We present a case of pseudoaneurysm of the right hepatic artery post-laparoscopic cholecystectomy. The patient presented with abdominal pain, vomiting, and hemodynamic failure on postoperative day 45. Magnetic resonance imaging (MRI) showed a large hematoma and a pseudoaneurysm of the right hepatic artery. A laparotomy was performed, and a large hematoma was found and evacuated. After the pringle maneuver, the pseudoaneurysm was resected. The right hepatic artery was ligated with clips, and a sub-hepatic drain was placed.

The non-availability of emergency embolization forced surgical closure of the right hepatic artery, which is still the first-line treatment for such cases. Injury of the right hepatic artery is a rare complication, often overlooked by surgeons, and requires early diagnosis. Surgical treatment is reserved for cases of embolization failure or hemodynamic instability.