Uterine artery pseudoaneurysm caused by hysteroscopic surgery: A case report

BACKGROUND We report a case of uterine artery pseudoaneurysm(UAP)occurrence during hysteroscopic endometrial polypectomy and its treatment via uterine artery embolization(UAE).CASE SUMMARY A 48-year-old primigravid,primiparous patient was incidentally found to have an endometrial polyp during a health checkup,and underwent a hysteroscopic polypectomy at another hospital.Her cervix was dilated with a Laminken-R®device.After the Laminken-R®was withdrawn,a large amount of genital bleeding was observed.This bleeding persisted after the hysteroscopic polypectomy,and,as hemostasis became impossible,the patient was transferred to our hospital by ambulance.On arrival,transvaginal ultrasonography revealed a 3-cm hypoechoic mass with a swirling internal pulse on the right side of the uterus,and color Doppler ultrasonography showed feeder vessels penetrating the mass.Pelvic contrast-enhanced computed tomography(CT)confirmed the presence of a mass at this site,and vascular proliferation was observed within the uterine cavity.Consequently,UAP was diagnosed,and UAE was performed.The patient’s postoperative course was uneventful,and 6 mo post-UAE,no recurrence of blood flow to the UAP was observed.CONCLUSION When abnormal genital bleeding occurs during hysteroscopic surgery,ultrasonography and contrast-enhanced CT can assist in the detection of early UAPs.

Managing uterine artery pseudoaneurysm post-hysteroscopic surgery:Clinical insights and future directions

This editorial discusses the case report by Kakinuma et al,which details a rare occurrence of uterine artery pseudoaneurysm following hysteroscopic surgery.The case highlights diagnostic challenges and management strategies for this uncommon complication.The editorial explores the implications for clinical practice,emphasizing the importance of early recognition and appropriate intervention to prevent potential severe outcomes.Future research directions to increase the understanding and management of uterine artery pseudoaneurysm in similar clinical settings.

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

AIM: To evaluate the effects of extrahepatic collaterals to the liver on liver damage and patient outcome after embolotherapy for the ruptured hepatic artery pseudoa- neurysm following hepatobiliary pancreatic surgery. METHODS: We reviewed 9 patients who underwent transcatheter arterial embolization (TAE) for the ruptured hepatic artery pseudoaneurysm following major hepato- biliary pancreatic surgery between June 1992 and April 2006. We paid special attention to the extrahepatic arte- rial collaterals to the liver which may affect post-TAE liver damage and patient outcome. RESULTS: The underlying diseases were all malignan- cies, and the surgical procedures included hepatopancre- atoduodenectomy in 2 patients, hepatic resection with removal of the bile duct in 5, and pancreaticoduodenec- tomy in 2. A total of 11 pseudoaneurysm developed: 4 in the common hepatic artery, 4 in the proper hepatic artery, and 3 in the right hepatic artery. Successful he- mostasis was accomplished with the initial TAE in all patients, except for 1. Extrahepatic arterial pathways to the liver, including the right inferior phrenic artery, the jejunal branches, and the aberrant left hepatic artery, were identified in 8 of the 9 patients after the completion of TAE. The development of collaterals depended on the extent of liver mobilization during the hepatic resection, the postoperative period, the presence or absence of an aberrant left hepatic artery, and the concomitant arte- rial stenosis adjacent to the pseudoaneurysm. The liver tolerated TAE without significant consequences when at least one of the collaterals from the inferior phrenic ar-tery or the aberrant left hepatic artery was present. One patient, however, with no extrahepatic collaterals died of liver failure due to total liver necrosis 9 d after TAE. CONCLUSION: When TAE is performed on ruptured hepatic artery pseudoaneurysm, reduced collateral path- ways to the liver created by the primary surgical proce- dure and a short postoperative interval may lead to an unfavorable outcome.

Pseudoaneurysm following laparoscopic cholecystectomy

BACKGROUND:Laparoscopic cholecystectomy(LC)is the operation of choice for removal of the gallbladder. Unrecognized bile duct injuries present with biliary peritonitis and systemic sepsis.Bile has been shown to cause damage to the vascular wall and therefore delay the healing of injured arteries leading to pseudoaneurysm formation.Failure to deal with bile leak and secondary infection may result in pseudoaneurysm formation. This study was to report the incidence and outcomes of pseudoaneurysm in patients with bile leak following LC referred to our hospital. METHODS:A retrospective analysis of our prospectively maintained liver database using pseudoaneurysm, bile leak and bile duct injury following laparoscopic cholecystectomy from January 2000 to December 2005 was performed. RESULTS:A total of 86 cases were referred with bile duct injury and bile leak following LC and of these,4 patients (4.5%)developed hepatic artery pseudoaneurysm(HAP) presenting with haemobilia in 3 and massive intra- abdominal bleed in 1.Selective visceral angiography confirmed pseudoaneurysm of the right hepatic artery in 2 cases,cystic artery stump in one and an intact but ectatic hepatic artery with surgical clips closely applied to the right hepatic artery at the origin of the cystic artery in the fourth case.Effective hemostasis was achieved in 3 patients with coil embolization and the fourth patient required emergency laparotomy for severe bleeding and hemodynamic instability due to a ruptured right hepatic artery.Of the 3 patients treated with coil embolization, 2 developed late strictures of the common hepatic duct. . (CHD)requiring hepatico-jejunostomy and one developed a stricture of left hepatic duct.All the 4 patients are alive at a median follow up of 17 months(range 1 to 65)with normal liver function tests. CONCLUSIONS:HAP is a rare and potentially life- threatening complication of LC.Biloma and subsequent infection are reported to be associated with pseudoaneurysm formation.Late duct stricture is common either due to unrecognized injury at LC or secondary to ischemia after embolization.

Hemobilia secondary to hepatic artery pseudoaneurysm: An unusual complication of bile leakage in a patient with a history of a resected Ⅲb Klatskin tumor

We report a case of a 74-year-old woman with a 16-year history of a double bilo-enteric anastomosis due to resected hilar cholangiocarcinoma [Type IIIb Klatskin tumor]. The patient presented with cholangitis secondary to benign anastomotic stenosis which resulted in a large intrahepatic biloma. In order to restore the patency of the anastomosis and overcome cholangitis, several attempts took place, including endobiliary stenting, balloon-assisted biloplasty and transhepatic billiary drainage. Anastomotic patency was achieved, complicated, however, by persistent upper gastro-intestinal bleeding, presented as hemobilia. A biloma-induced pseudoaneurysm of the left hepatic artery was diagnosed. This had ruptured into the biliary tract, and presented the actual cause of the hemobilia. Selective embolism of the pseudoaneurysm resulted in control of the hemorrhage, and was successfully combined with transhepatic dilatation of the anastomosis and percutaneous drainage of the biloma. The patient was ultimately cured and seems to be in excellent condition, 5 mo after treatment.

Hemosuccus pancreaticus caused by gastroduodenal artery pseudoaneurysm associated with chronic pancreatitis: A case report and review of literature

BACKGROUND Hemosuccus pancreaticus is a very rare but severe form of upper gastrointestinal hemorrhage.The most common etiology is peripancreatic pseudoaneurysm secondary to chronic pancreatitis.Due to the rarity of gastroduodenal artery pseudoaneurysms,most of the current literature consists of case reports.Limited knowledge about the disease causes diagnostic difficulty.CASE SUMMARY A 39-year-old man with a previous history of chronic pancreatitis was hospitalized due to hematemesis and melena for 2 wk,with a new episode lasting 1 d.Two weeks prior,the patient had visited a local hospital for repeated hematemesis and melena.Esophagogastroduodenoscopy indicated hemorrhage in the descending duodenum.The patient was discharged after the bleeding stopped,but hematemesis and hematochezia recurred.Bedside esophagogastroduodenoscopy showed no obvious bleeding lesion.On admission to our hospital,he had hematemesis,hematochezia,left middle and upper abdominal pain,severe anemia,and elevated blood amylase.After admission,intermittent hematochezia was observed.Abdominal contrast-enhanced computed tomography revealed a pseudoaneurysm in the pancreas head.Angiography confirmed the diagnosis of gastroduodenal artery pseudoaneurysm.The pseudoaneurysm was successfully embolized with a coil and cyanoacrylate.No bleeding was observed after the operation.After discharge from the hospital,a telephone follow-up showed no further bleeding signs.CONCLUSION Hemosuccus pancreaticus caused by gastroduodenal artery pseudoaneurysm associated with chronic pancreatitis is very rare.This diagnosis should be considered when upper gastrointestinal bleeding and abdominal pain are intermittent.Abdominal enhanced computed tomography and angiography are important for diagnosis and treatment.

Late hepatic artery pseudoaneurysm:A rare complication after resection of hilar cholangiocarcinoma

We report an unusual pathological entity of a pseudoaneurysm of the right hepatic artery, which developed two years after the resection of a type 11 hilar cholangiocarcinoma and secondary to an excessive skeletonization for regional lymphadenectomy and neoadjuvant external-beam radiotherapy. After a sudden and massive hematemesis, a multidetector computed tomographic angiography （MDCTA） showed a hepatic artery pseudoaneurysm. Angiography with embolization of the pseudoaneurysm was attempted using microcoils with adequate patency of the hepatic artery and the occlusion of the pseudoaneurysm. A new episode of hematemesis 3 wk later revealed a partial revascularization of the pseudoaneurysm. A definitive interventional radiological treatment consisting of transarterial embolization （TAE） of the right hepatic artery with stainless steel coils and polyvinyl alcohol particles was effective and welltolerated with normal liver function tests and without signs of liver infarction.

Hepatic artery pseudoaneurysm caused by acute idiopathic pancreatitis

Hepatic artery pseudoaneurysm(HAP) is a very rare disease but in cases of complication,there is a very high mortality.The most common cause of HAP is iatrogenic trauma such as liver biopsy,transhepatic biliary drainage,cholecystectomy and hepatectomy.HAP may also occur with complications such as infections or inflammation associated with septic emboli.HAP has been reported rarely in patients with acute pancreatitis.As far as we are aware,there is no report of a case caused by acute idiopathic pancreatitis,particularly.We report a case of HAP caused by acute idiopathic pancreatitis which developed in a 61-year-old woman.The woman initially presented with acute pancreatitis due to unknown cause.After conservative management,her symptoms seemed to have improved.But eight days after admission,abdominal pain abruptly became worse again.Abdominal computed tomography(CT) was rechecked and it detected a new HAP that was not seen in a previous abdominal CT.Endoscopic retrograde cholangiopancreatography(ERCP) was performed because of a suspicion of hemobilia as a cause of aggravated abdominal pain.ERCP confirmed hemobilia by observing fresh blood clots at the opening of the ampulla and several filling defects in the distal common bile duct on cholangiogram.Without any particular treatment such as embolization or surgical ligation,HAP thrombosed spontaneously.Three months after discharge,abdominal CT demonstrated that HAP in the left lateral segment had disappeared.

Endovascular treatment of a ruptured pseudoaneurysm of the internal carotid artery in a patient with nasopharyngeal cancer:A case report

BACKGROUND Radiation therapy(RT)for nasopharyngeal cancer can cause several complications.In rare cases,an internal carotid artery pseudoaneurysm can occur,which can be fatal.We report the experience of a nasopharyngeal cancer patient who underwent radiation therapy and subsequently developed a fatal pseudoaneurysm of the petrous internal carotid artery.CASE SUMMARY A 39-year-old man was diagnosed with nasopharyngeal cancer 2 years ago(American Joint Committee on Cancer Stage T3N2M0)and received concurrent chemoradiation therapy.He subsequently relapsed and received chemotherapy.One week after the 4th cycle of chemotherapy,he was admitted to the emergency room of our hospital because of massive epistaxis accompanied by a headache.A pseudoaneurysm of the petrous internal carotid artery was confirmed by digital subtraction angiography(DSA).Stent-assisted endovascular coil embolization was performed and complete occlusion was achieved.No pseudoaneurysm was observed on DSA after coil embolization;however,intermittent epistaxis was maintained even after coil embolization.After seven days,a diagnostic laryngoscopy was performed.Massive bleeding occurred after aspiration of the blood clot during the laryngoscopy and the patient died of hypovolemic shock.In this case,epistaxis may have been a sign of pseudoaneurysm;therefore,treatment such as embolization should be performed promptly,and careful management should be undertaken after treatment.CONCLUSION This case highlights a rare,serious complication of RT in nasopharyngeal cancer and how it should be recognized and treated.

Cystic artery pseudoaneurysm:A case report

BACKGROUND Cystic artery pseudoaneurysm is a condition rarely encountered by clinicians;this,its etiology and presentation as well as appropriate treatments are not well studied.Although it is treated by removal of the diseased gallbladder and cystic artery,such surgery can be difficult and risky if acute inflammation with bleeding occurs,and not every patient can tolerate the surgery.CASE SUMMARY An 81-year-old man complained of epigastric pain and tarry stool passage that lasted for 3 d.He had a medical history of poor cardiopulmonary function.The computed tomographic scan of abdomen showed cystic artery pseudoaneurysm and dilatation of gallbladder.Because of high adverse outcomes related to general anesthesia,the patient was successfully managed with endovascular embolization for this cystic artery pseudoaneurysm and percutaneous drainage for the distended gallbladder.CONCLUSION A patient with cystic artery pseudoaneurysm may quickly deteriorate with the occurrence of concurrent arterial bleeding and sepsis.This report presents the case of a patient who did not undergo surgery due to multiple cardiopulmonary comorbidities and whose condition was managed successfully with embolization and biliary drainage.Endovascular embolization and biliary drainage may provide an alternative option to manage this complicated condition.

Massive bleeding from a gastric artery pseudoaneurysm in hepatocellular carcinoma treated with atezolizumab plus bevacizumab: A case report

BACKGROUND The combination of atezolizumab(ATZ)and bevacizumab(BVZ)was approved as first-line systemic therapy for advanced hepatocellular carcinoma(HCC)owing to its superior rates of response and patient survival.However,ATZ+BVZ is associated with increased risk of upper gastrointestinal(GI)bleeding,including arterial bleeding,which is rare and potentially fatal.We present a case of massive upper GI bleeding from a gastric pseudoaneurysm in a patient with advanced HCC who had been treated with ATZ+BVZ.CASE SUMMARY A 67-year-old man presented with severe upper GI bleeding after atezolizumab(ATZ)+bevacizumab(BVZ)therapy for HCC.Endoscopy failed to detect the bleeding site.Digital subtraction angiography revealed a gastric artery pseudoaneurysm and contrast extravasation from the inferior splenic artery and a branch of the left gastric artery.Successful hemostasis was achieved with embolization.CONCLUSION HCC patients who have been treated with ATZ+BVZ should be followed for 3 to 6 mo to monitor for development of massive GI bleeding.Diagnosis may require angiography.Embolization is an effective treatment.

Risk factors of renal artery pseudoaneurysm following partial nephrectomy

Objective To study the risk factors of renal artery pseudoaneurysm ( RAP) following partial nephrectomy. Methods Open partial nephrectomhy was performed on a total of 464 cases of renal cell cancer from July 2003 to May 2010. Five patients ( 1. 1% ) had postoperative hem-

Timely identification and treatment of uterine artery pseudoaneurysm after hysteroscopic procedures

Uterine artery pseudoaneurysm(UAP)is a rare but potentially life-threatening complication that can occur following hysteroscopic surgery for endometrial polyp resection.This article discusses the case study by Kakinuma et al,which highlights the successful diagnosis and treatment of UAP in a 48-year-old primiparous woman.Utilizing advanced imaging techniques such as ultrasound and computed tomography(CT),the medical team was able to promptly identify the UAP and subsequently perform a uterine artery embolization to treat the condition.The study underscores the critical need for rapid diagnosis and intervention to prevent severe outcomes and provides practical clinical recommendations for managing similar cases.This article aims to expand on the study’s findings,discuss the clinical implications,and suggest future research directions to optimize the management of UAP post-hysteroscopic surgery.

Recurrent gastrointestinal bleeding and hepatic infarction after liver biopsy

Hepatic artery pseudoaneurysms(HAP)are rare events,particularly after liver biopsy,but can be associated with serious complications.Therefore a high suspicion is necessary for timely diagnosis and appropriate treatment.We report on a case of HAP that potentially formed after a liver biopsy in a patient with sarcoidosis.The HAP in our case was virtually undetectable initially by angiography but resulted in several complications including recurrent gastrointestinal bleeding,hemorrhagic cholecystitis and finally hepatic infarction with abscess formation until it became detectable at a size of 5-mm.The patient remains asymptomatic over a year after endovascular embolization of the HAP.In this report,we demonstrate that a small HAP can avoid detection by angiography at an early stage while being symptomatic for a prolonged course.A high clinical suspicion with a close clinical/radiological follow-up is needed in symptomatic patients with history of liver biopsy despite initial negative work up.Once diagnosed,HAP can be safely and effectively treated by endovascular embolization.

Contrast-enhanced ultrasound in detection and follow-up of pancreaticoduodenal artery pseudoaneurysm： a case report

Pancreaticoduodenal artery pseudoaneurysm is one kind of rare splanchnic artery aneurysm. Hemorrhage from the lesion could be life-threatening. We present a case which color Doppler ultrasound and computed tomography angiography （CTA） only showed pancreatic pseudocyst on the background of chronic pancreatitis at first, but contrast-enhanced ultrasound detected blood flow in the pseudocyst and a pancreaticoduodenal artery pseudoaneurysm was worked up several days after. Finally, the pancreaticoduodenal artery pseudoaneurysm was confirmed by digital subtracted angiography. It might suggest the potential advantage of contrast-enhanced ultrasound in evaluating this kind of disease in comparison of CTA.

Successful treatment of spontaneous rupture of the internal carotid artery in an acute promyelocytic leukemia patient using ultrasound-guided thrombin injection

Spontaneous rupture and bleeding from the carotid artery in acute promyelocytic leukemia （APL）patients leading to pseudoaneurysm （PSA） formation has not been reported. We first successfully treated an APL patient with leli internal carotid artery rupture during chemotherapy leading to PSA using ultrasound-guided thrombin iniection （UGTI）.