Iatrogenic Pseudoaneurysm of Splanchnic Artery after Hepato-Biliary-Pancreatic Surgery

ABSTRACT

Extensive hepato-biliary-pancreatic (H-B-P) surgery is still associated with a high postoperative morbidity and mortality than other intraabdominal organ operation. Especially, iatrogenic pseudoaneurysm of splanchnic artery after major H-B-P surgery, although not frequent, can be a devastating and often leads to fatal hemorrhage due to aneurysm rupture. In a series of 300 patients who underwent major hepato-biliary-pancreatic surgery between 1989 and 1995, 6 patients with iatrogenic pseudoaneurysm were reviewed retrospectively. There were 1 hepatic artery pseudoaneurysm after hepatopancreaticoduodenectomy and portal vein resection for Klatskin tumor, 1 proper hepatic artery pseudoaneurysm after extended right hepatectomy and bile duct resection for Klatskin tumor, 1 superior mesenteric artery and common hepatic artery pseudoaneurysm after pancreatoduodenectomy for periampullary cancer, 1 hepatic artery pseudoaneurysm after pancreatoduodenectomy for periampullary cancer,1 pseudoaneurysm of anastomotic site between hepatic artery and splenic artery after type II regional total pancreatectomy for periampullary cancer, and 1 pseudoaneurysm of iliac artery conduit for hepatic artery reconstruction after orthotopic liver transplantation. Five of these 6 pseudoaneurysms were resulted from aggressive radical surgery including skeletonization of hepatoduodenal ligament. Pseudoaneurysm should be highly suspected when continued leukocytosis, fever and gastrointestinal bleeding such as hematemesis or melena are shown. Celiac angiogram should be considered for the early detection of pseudoaneurysm. Angiographic embolization might be considered as a primary treatment, however, if it is not successful, early surgical intervention might be an another life-saving option.