Gallbladder ulcer eroding the cystic artery: a rare cause of hemobilia

Contini, Sandro; Uccelli, Mario; Sassatelli, Romano; Pinna, Ferdinando; Corradi, Domenico

doi:10.1016/j.amjsurg.2008.12.034

Cited by 15 publications

(15 citation statements)

References 3 publications

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“…Endoscopy is the initial investigation of choice in evaluation of upper gastrointestinal haemorrhage. The classic observation of blood coming from inside the papilla has been reported to be diagnostic in haemobilia [7,13,14,19,29]. In this case endoscopy demonstrated an ulcer in the first part of the duodenum with blood clot, similar observations have also been reported in literature where a cholecystoenteric fistula site was confused as a duodenal ulcer [14,32].…”

Section: Discussionsupporting

confidence: 77%

“…Worm infestations have been reported to cause haemobilia [2] and an unusual history of passage of worm in the vomitus preceded the acute episode of gastrointestinal bleed in this case. Another cause of non-aneurysmal spontaneous cystic artery bleed reported is due to erosion of a gallbladder ulcer into the cystic artery [29] however no definite ulcer was seen in this case. Sloughing of the gallbladder mucosa as seen in necrotizing infections may also lead to intramural fistulation and haemorrhagic emphysematous cholecystitis [5].…”

Section: Discussionmentioning

confidence: 73%

“…In early literature embolization of proximal arteries were performed with resultant infarction and organ damage [37]. With the availability of fine catheters super selective catheterization and embolization of the feeder vessel or pseudoaneurysm with micro coils can control the active bleed [37] as also facilitate subsequent laparoscopic cholecystectomy has been recommended [7,8,14,19,29]. Even in open cholecystectomy torrential haemorrhage can occur from accidental rupture of arterial pseudoaneurysm and establishing a proximal control before venturing into the area of pesudoaneurysm is advisable [13].…”

Section: Discussionmentioning

confidence: 99%

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Emergency cholecystectomy and hepatic arterial repair in a patient presenting with haemobilia and massive gastrointestinal haemorrhage due to a spontaneous cystic artery gallbladder fistula masquerading as a pseudoaneurysm

et al. 2013

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BackgroundHaemobilia usually occurs secondary to accidental or iatrogenic hepatobiliary trauma. It can occasionally present with cataclysmal upper gastrointestinal haemorrhage posing as a life threatening emergency. Haemobilia can very rarely be a complication of acute cholecystitis. Here we report a case of haemobilia manifesting as massive gastrointestinal haemorrhage in a patient without any prior history of biliary surgery or intervention and present a brief review of literature.Case presentationA 22 year old male admitted with history suggestive of acute cholecystitis subsequently developed waxing waning jaundice and recurrent episodes of upper gastrointestinal bleed. Endoscopy showed an ulcer in the first part of duodenum with a clot, no active bleed was visible. Angiography was suggestive of a ruptured pseudoaneurysm in the vicinity of the right hepatic artery probably originating from the cystic artery. Coil embolization was tried but the coil dislodged into the right branch of hepatic artery distal to the site of pseudoaneurysm. Review of angiographic video in light of operative findings demonstrated a fistulous communication between cystic artery and gallbladder as the cause, a simultaneous cholecystoduodenal fistula was also noted. Retrograde cholecystectomy, closure of cholecystoduodenal fistula and right hepatic arteriotomy with retrieval of the endo-coil and hepatic arterial repair was performed.ConclusionFistula between the cystic artery and gallbladder has been commonly reported to occur after laparoscopic cholecystectomy. Spontaneous fistulous communication, i.e. in the absence of any prior trauma or intervention, between cystic artery and gallbladder is rare with very few reports in literature. Aetiopathogenesis of the disease, in the context of current literature is reviewed. The diagnostic dilemma posed by the confounding finding of an ulcer in the duodenum, the iconic video angiographic depiction as also the therapeutic challenge of a failed embolization with consequent microcoil migration and primary hepatic arterial repair in the emergency situation is discussed.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

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Emergency cholecystectomy and hepatic arterial repair in a patient presenting with haemobilia and massive gastrointestinal haemorrhage due to a spontaneous cystic artery gallbladder fistula masquerading as a pseudoaneurysm

et al. 2013

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“…Spontaneous intra-cholecystic bleeding is a rare occurrence which was described in patients with gallstones [2] gallbladder malignancy [3] and patients receiving anticoagulant therapy [4]. Bleeding as a result of an ulcer eroding into an otherwise normal cystic artery or pseudoaneurysm of the cystic artery is rare [5-7].…”

Section: Discussionmentioning

confidence: 99%

Gallbladder ulcer erosion into the cystic artery: a rare cause ofupper gastro-intestinal bleeding Case report

et al. 2010

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Intra luminal gallbladder bleeding is a rare cause of hemobilia that results in upper gastro-intestinal bleeding. In this case report we present a patient who presented with melena and eventually was diagnosed as bleeding from an ulcer in the gallbladder which was induced by gallstones and eroded into the cystic artery. Surgery revealed perforation of gallbladder which was the result of a pressure sore induced by a second gallstone.

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“…14 The paucity of cystic artery pseudoaneurysms despite the high incidence of cholecystitis may reflect early occlusion of the artery as part of the inflammatory process. 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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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Gallbladder ulcer eroding the cystic artery: a rare cause of hemobilia

Cited by 15 publications

References 3 publications

Emergency cholecystectomy and hepatic arterial repair in a patient presenting with haemobilia and massive gastrointestinal haemorrhage due to a spontaneous cystic artery gallbladder fistula masquerading as a pseudoaneurysm

Emergency cholecystectomy and hepatic arterial repair in a patient presenting with haemobilia and massive gastrointestinal haemorrhage due to a spontaneous cystic artery gallbladder fistula masquerading as a pseudoaneurysm

Gallbladder ulcer erosion into the cystic artery: a rare cause ofupper gastro-intestinal bleeding Case report

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

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