Arteriogenic hemorrhage of the anastomotic loop after choledochojejunostomy: case series and literature review

TL;DR

This paper reports three cases of severe bleeding after bile duct surgery, highlighting the importance of timely diagnosis and treatment options like embolization or surgery.

Contribution

The paper contributes a case series and literature review on arteriogenic hemorrhage after choledochojejunostomy, emphasizing diagnostic and therapeutic strategies.

Findings

Arteriogenic hemorrhage is a life-threatening complication following choledochojejunostomy.

Transarterial embolization is an effective first-line treatment for this condition.

Laparotomy is a critical salvage strategy for cases unresponsive to interventional therapy.

Abstract

Arteriogenic hemorrhage of the anastomotic loop after choledochojejunostomy is a life-threatening, and complex postoperative complication, necessitating a comprehensive diagnostic approach integrating clinical manifestations, imaging findings, and results from endoscopy or angiography. We present 3 clinical cases: a 22-year-old male who developed hemorrhagic shock 28 days after laparoscopic choledochal cyst resection, due to an anomalous communication between the right hepatic artery stump and the choledochojejunostomy, and achieving hemostasis via transarterial embolization; a 71-year-old female with painless hematochezia and shock 1 month after laparoscopic radical resection of middle common bile duct cancer, due to a proper hepatic artery pseudoaneurysm, whose symptoms were effectively controlled after transarterial embolization; and a 44-year-old male with hematochezia on 11 days after laparoscopic choledochal cyst resection, who failed interventional management, requiring laparotomy for gastroduodenal artery stump ligation to achieve hemostasis. Key etiologies of this complication encompass anastomotic leakage and vascular erosion; Timely interventional interventions (eg, transarterial embolization, covered stent placement) serve as effective first-line management, whereas laparotomy acts as a critical salvage strategy for refractory cases failing interventional therapy.

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