Acute cholecystitis with massive upper gastrointestinal bleed: A case report and review of the literature

Abstract

Background: Cystic artery pseudoaneurysm is a rare complication following cholecystitis. Its presentation with upper gastrointestinal hemorrhage (UGIH) is even rarer. Thirteen patients with cystic artery pseudoaneurysm have been reported in the literature but only 2 of them presented with UGIH alone.

Cystic Artery Pseudoaneurysm: Over Warfarinisation and Management

“…If endoscopy reveals bleeding through the papilla of Vater, haemobilia could be more readily diagnosed [8]. It is possible to miss bleeding from the papilla in patients with haemobilia as it may be intermittent in nature or simultaneous rupture into the duodenum may provide an alternative route for the blood to come out [7].…”

“…encirclement of the proximal hepatic artery in preparation for temporal vascular clamping) may be mandatory in order to avoid serious and uncontrollable bleeding [5]. Serious bleeding can be precipitated, when dissection is performed in an area where there is evidence of acute inflammation containing a pseudoaneurysm [7].…”

“…However, ligation of the cystic artery pseudoaneurysm with cholecystectomy is the final treatment of choice [7]. The proximal control of the hepatic artery (i.e.…”

“…Visceral inflammation adjacent to the arterial wall damages the adventitia and causes thrombosis of the vaso-vasorum resulting in a localised weakness in the vessel wall [1,5]. In addition to acute inflammation, severe damage to the GB wall by a large gallstone eroding into the cystic artery can accelerate the formation of a pseudoaneurysm [7].…”

“…This enhances in the arterial phase. It helps to confirm the diagnosis in patients with an equivocal Doppler examination before proceeding for an invasive procedure and may localise the blood vessel involved [7]. A selective hepatic artery angiography is thought to be the gold standard in highlighting the splanchnic vascular system and the pseudoaneurysm can be treated simultaneously via coil embolization [9].…”