Cystic artery bleeding due to blunt gallbladder injury: computed tomography findings and treatment with transcatheter arterial embolization

Abstract

Blunt gallbladder injury is rare, and bleeding from the cystic artery due to blunt trauma is even rarer. We report herein a case of extraluminal bleeding of the gallbladder in a patient following blunt abdominal trauma. Contrast-enhanced computed tomography revealed pericholecystic fluid and extravasation of contrast material in the subcapsular liver space adjacent to the gallbladder. Abdominal digital subtraction angiography revealed pseudoaneurysm originating from a branch of the cystic artery. Successful treatment was achieved using selective transcatheter embolization, and cholecystectomy was not required.

An unusual cause of acute internal haemorrhage: cystic artery pseudoaneurysm secondary to acute cholecystitis

“…7,15 In this case report, we describe a patient who had spontaneous cystic artery 14 whilst contrast CT might reveal pooling of contrast in the gallbladder lumen. 10,11,14 Endoscopic retrograde cholangiopancreaticography (ERCP) may show filling defects from blood clots within the common bile duct. 15 The diagnosis can be confirmed with intra-arterial angiography, which could also enable selective embolisation of the bleeding vessel.…”

“…Spontaneous cystic artery haemorrhage is a rare condition. [1][2][3][4][5][6][7][8][9] This condition has been previously reported in the context of blunt abdominal trauma, [10][11][12] von Willebrand's disease, metachromatic leukodystrophy and polyarteritis nodosa. 13 Additionally, cystic artery haemorrhage is known to occur in the presence of cholecystitis, possibly as a consequence of pseudoaneurysm formation.…”

“…Selective angiographic embolisation of cystic artery haemorrhage has been reported with good outcomes. 8,10,[14][15][16] Interval cholecystectomy may be performed 14,15 but is not essential. 8,10,16 In our patient, we proceeded to theatre after resuscitation.…”

“…8,10,[14][15][16] Interval cholecystectomy may be performed 14,15 but is not essential. 8,10,16 In our patient, we proceeded to theatre after resuscitation. We decided not to undergo selective angiography and embolisation because the patient had clinical and radiological evidence of active cystic artery haemorrhage and we believed operative haemorrhage control was indicated.…”

Imaging of Traumatic and Non-Traumatic Cystic Artery Bleeding

“…In trauma settings, multiphase CT represents the gold standard in stable patients as the first diagnostic step; CT can assess the presence of hemoperitoneum, the active bleeding and its source [18,19]. Isolated cystic artery trauma is an exceptional event, this may be explained by the protected anatomical location of the cystic artery course along the hepatobiliary triangle [18,20]. In blunt trauma, the more common presentation is hemoperitoneum with active extravasation due to cystic artery shear damage along its course within the gallbladder bed (Figure 2-4).…”