双重病理,单一解决:胆囊切除术后并发胆管损伤及肝动脉假性动脉瘤的介入放射治疗。

IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL
Annals of Medicine and Surgery Pub Date : 2025-07-23 eCollection Date: 2025-09-01 DOI:10.1097/MS9.0000000000003634
Burhan Zafar, Tanveer Ul Haq, Mallick Muhammad Zohaib Uddin, Huzafa Ali, Aisha Tariq, Ayesha Nazeef, Junaid Iqbal, Jeevan Gyawali
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引用次数: 0

摘要

腹腔镜胆囊切除术(LC)是胆囊病理的金标准,但存在胆管损伤(BDI)和血管并发症的风险,如肝动脉假性动脉瘤(HAP)。虽然BDI发生率为0.3-0.5%,但HAP罕见(0.8%),并发损伤非常罕见。病例介绍:一名31岁男性,LC后出现BDI和HAP,通过介入放射学(IR)成功治疗。患者经LC治疗后转为开腹胆囊切除术,出现发热、呕吐、腹痛8天的主诉。通过肝总动脉覆盖支架对4.5 mm HAP进行血管栓塞,并在计算机断层扫描引导下引流感染的大胆囊瘤。持续性胆漏需要经皮经肝胆道引流术(PTBD)。手术后,患者病情明显好转,出院时无并发症。讨论:红外光谱在胆道病变的识别和治疗中起着重要作用。IR是处理双重并发症的关键部分,并建议微创替代再手术。孤立的BDI或HAP有文献记载,但同时发生BDI或HAP的情况很少见,关于基于ir的治疗的文献也很有限。结论:血管栓塞联合胆道引流是一种微创有效的方法,避免了进一步的手术干预。本病例报告为双重并发症的处理提供了有价值的见解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Dual pathology, single solution: concurrent bile duct injury and hepatic artery pseudoaneurysm managed by interventional radiology after converted cholecystectomy.

Dual pathology, single solution: concurrent bile duct injury and hepatic artery pseudoaneurysm managed by interventional radiology after converted cholecystectomy.

Dual pathology, single solution: concurrent bile duct injury and hepatic artery pseudoaneurysm managed by interventional radiology after converted cholecystectomy.

Introduction: Laparoscopic cholecystectomy (LC) is the gold standard for gallbladder pathologies, but carries risks of bile duct injury (BDI) and vascular complications, such as hepatic artery pseudoaneurysm (HAP). While BDI occurs in 0.3-0.5% of cases, HAP is rare (0.8%), with concurrent injuries being exceptionally uncommon.

Case presentation: A 31-year-old male who developed BDI and HAP after LC was managed successfully through interventional radiology (IR). The patient was managed by LC, which was converted to an open cholecystectomy, and presented with complaints of fever, vomiting, and abdominal pain for 8 days. Angioembolization of the 4.5 mm HAP via a covered stent in the common hepatic artery and computed tomography-guided drainage of a large infected biloma were performed. Persistent bile leak required percutaneous transhepatic biliary drainage (PTBD). After the procedure, the patient's condition improved drastically, and the patient was discharged without complications.

Discussion: IR plays a significant role in the identification and treatment of biliary lesions. IR's key part in dealing with dual complications and suggests a minimally invasive alternative to reoperation. Isolated BDI or HAP has been documented, but the co-occurrence of BDI or HAP is rare, and there is limited literature on IR-based management.

Conclusion: The combined use of angioembolization and biliary drainage highlights a minimally invasive and effective approach to avoid the need for further surgical intervention. This case report provides valuable insight into the management of dual complications.

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来源期刊
Annals of Medicine and Surgery
Annals of Medicine and Surgery MEDICINE, GENERAL & INTERNAL-
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