Gallbladder and Bile Duct Necrosis after Surgery for Stanford Type A Aortic Dissection Finally Performed Choledohojejunostomy—A Case Report—

Abstract

We experienced a case of a 77-year-old man who suffered from gallbladder necrosis developed a month after the emergent surgery for acute Stanford type A aortic dissection. An abdominal CT scan showed pericholecystic fluid and unclear gallbladder wall, revealing acalculous necrotizing cholecystitis. We performed open cholecystectomy and abdominal cavity drainage. No gallstones were observed. Two days later, bile discharge was seen from the abdominal drain and an ENBD tube was placed. Cholangiography demonstrated bile leakage occurred from the intrapancreatic bile duct, and bile duct necrosis was diagnosed. The ENBD tube was replaced with an ERBD tube. On 8^th POD, the drain discharge got bloody and a dynamic CT scan revealed rupture of a pseudoaneurysm around the bile duct. TAE was performed in the PSPDA with coils. Bile discharge was persistent and finally, the drain tube could be removed 2 months after cholecystectomy. Further two months later, fever due to ERBD tube obstruction occurred and the ERBD tube was replaced. Bile duct stenosis was found around the embolization coils and cholangitis with bile duct stones occurred repeatedly. Eventually, choledochojejunostomy was performed. Although terminal organ ischemia occurs in about 30% of acute aortic dissection patients, gallbladder necrosis is very rare. In a review of the literature, all cases of acute gallbladder necrosis with or after acute aortic dissection were of Stanford type B.