Hepatic falciform artery bleed post laparoscopic tenckhoff catheter insertion
Presentation
Underlying end-stage renal failure, developed hypotension post laparoscopic Tenckoff catheter insertion.
Patient Data
Gross hemoperitoneum with hyperdense blood clots (right > left), predominantly perihepatic and pelvic in location.
Active contrast extravasation from hepatic falciform artery during arterial phase, visualized at right paramidline location, adjacent to port insertion site (above the level of umbilicus).
The active bleed is noted intraperitoneally with pooling of contrast in subsequent phases, located anterior to bowel loops. No rectus sheath hematoma.
Evidence of Tenchkoff with entry site at left lower abdomen, curled tip within pelvis. No contrast blush or outpouching from bilateral inferior epigastric arteries.
Case Discussion
Patient was immediately sent to operating theater as the surgeon in charge decided for emergency exploratory laparotomy instead of referral to interventional radiologist.
Intraoperatively, there was blood spurting from falciform artery. Ligation was performed.
Post-operatively, hemodynamic stability was achieved.
Falciform artery is an uncommon vascular anatomic variant that courses anteriorly through the falciform ligament into and supplying the supraumbilical anterior abdominal wall. It may have anastomoses with terminal branches of the internal thoracic artery and superior epigastric artery.
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