Arteriogenic hemorrhage of the anastomotic loop after choledochojejunostomy: case series and literature review

Arteriogenic hemorrhage of the anastomotic loop after choledochojejunostomy is a life-threatening, and complex postoperative complication, necessitating a comprehensive diagnostic approach integrating clinical manifestations, imaging findings, and results from endoscopy or angiography. We present 3 clinical cases: a 22-year-old male who developed hemorrhagic shock 28 days after laparoscopic choledochal cyst resection, due to an anomalous communication between the right hepatic artery stump and the choledochojejunostomy, and achieving hemostasis via transarterial embolization; a 71-year-old female with painless hematochezia and shock 1 month after laparoscopic radical resection of middle common bile duct cancer, due to a proper hepatic artery pseudoaneurysm, whose symptoms were effectively controlled after transarterial embolization; and a 44-year-old male with hematochezia on 11 days after laparoscopic choledochal cyst resection, who failed interventional management, requiring laparotomy for gastroduodenal artery stump ligation to achieve hemostasis. Key etiologies of this complication encompass anastomotic leakage and vascular erosion; Timely interventional interventions (eg, transarterial embolization, covered stent placement) serve as effective first-line management, whereas laparotomy acts as a critical salvage strategy for refractory cases failing interventional therapy.