The Telegraph
Since 1st March, 1999
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Blood poser in stone surgery

When 27-year-old Papiya Sil went for an innocuous laparoscopic cholecystectomy (removal of the gall bladder with stones), she hardly realised she was carrying a complication that would almost threaten her life.

During the operation, she started bleeding profusely, which was not controllable by usual surgical methods. So doctors turned the procedure into an open cholecystectomy. Within days, she recovered and was discharged. A couple of months on, however, she was at Mahesh Goenka’s chamber at AMRI-Apollo Hospitals in a state of shock.

She was vomiting blood and her haemoglobin count was an abysmal three. Goenka and his team somehow resuscitated her, but a CT scan showed a huge blood clot in the right side of the liver. An emergency endoscopy revealed blood in her duodenum. “She was bleeding from the bile duct and there was a lot of blood in the stomach, too,” recalls Goenka, now chief gastroenterologist, Apollo Gleneagles Hospitals.

As the patient continued to throw up blood, she was shifted to Apollo Gleneagles for an urgent angiography, once she became slightly stable. The angiography, done by the team of interventional radiologists Manash Saha and Usha Goenka, revealed an aneurysm from the right hepatic artery (which supplies blood to the right side of the liver).

The interventional radiologists blocked the problem artery with gelfoam and coils. The next day, the patient was shifted back to AMRI and released after a few days in “stable condition”. A repeat CT scan showed the bleeding was controlled and another endoscopy, too, revealed no blood.

Papiya has recovered now, but the doctors who treated her during her prolonged ordeal seem to have a slight difference of opinion on the condition that had afflicted her.

“It was a pseudo-aneurysm. A blood vessel got dilated and blood was draining into the duodenum,” observes Mahesh Goenka.

Saha, however, is convinced it was “a case of an abnormally arising artery” to the gall bladder from the right hepatic artery (an aberrant cystic artery). “This is a known but rare condition and almost impossible to diagnose preoperatively. The only treatment option in such a case is to block the bleeding vessel, as was done with this patient,” he says.

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