Hepatic Artery Pseudoaneurysm After Laparoscopic Cholecystectomy: A Rare Cause of Gastrointestinal Bleeding.

Hepatic artery pseudoaneurysm (HAP) is a rare but serious complication after hepatobiliary surgery or pancreatitis. We present the case of a 33-year-old man with a history of recurrent pancreatitis complicated by portal vein thrombosis and gastric varices. Extensive workup did not reveal any etiology for his recurrent pancreatitis other than gallbladder sludge and stones. Therefore, he underwent a laparoscopic cholecystectomy as a potential source of pancreatitis. Post-cholecystectomy, he remained asymptomatic for a couple of months and later had recurrent episodes of upper gastrointestinal (GI) bleeding. He was investigated at the local hospital for his recurrent bleeding episodes and was advised to get injection sclerotherapy for his gastric varices. He presented to our institute following a massive fresh bleeding per rectum and severe anemia (hemoglobin of 3.3 g/dL). After initial resuscitation, an endoscopy was performed, which revealed well-covered gastric varices without any red warning sign or stigma of recent bleeding. There was a large yellow-based ulcer with surrounding edema in the duodenal bulb with visible pulsations; however, no vessels were visible. Subsequently, a CT angiogram was performed, which showed a large right HAP. He was immediately transferred to the interventional radiology suite, and endovascular stenting was successfully performed. The patient remained under observation for 48 hours without any further drop in hemoglobin or GI bleeding episodes. He was later discharged with outpatient follow-up. Although uncommon, a pseudoaneurysm after laparoscopic cholecystectomy should be suspected in patients with unexplained GI bleeding and a relevant surgical history. Imaging plays a key role in diagnosis, and endovascular management, such as stenting or embolization, is often preferred. This case highlights the importance of maintaining a high index of suspicion and acting quickly to prevent life-threatening complications.