Pseudoaneurysm of the cystic artery associated with upper gastrointestinal bleeding

Abstract

Pseudoaneurysm of the cystic artery is a cause of hemobilia, and is extremely rare, with only eight cases having been reported in the world literature. We report a case of pseudoaneurysm of the cystic artery in a 72-year-old Japanese man. The patient experienced epigastric pain and melena, and was found to have jaundice and liver dysfunction. Repeated gastroendoscopy did not reveal the cause of the alimentary tract bleeding; however, color-Doppler ultrasonography detected an aneurysm of the cystic artery in the gallbladder. Selective hepatic arteriography demonstrated that the posterior branch of the cystic artery was markedly dilated and that an aneurysm had formed in the midst of the artery. We diagnosed hemobilia due to the pseudoaneurysm of the cystic artery, and associated gastrointestinal bleeding. Cholecystectomy was performed immediately. Pathologically, the gallbladder showed acute calculous cholecystitis. This case emphasizes the importance of including hemobilia in the differential diagnosis whenever gastrointestinal bleeding is associated with signs of biliary disorder; color-Doppler imaging is a favorable modality for the diagnosis of pseudoaneurysm of the cystic artery.

Hepatic artery pseudoaneurysm associated with cholecystitis that ruptured into the gallbladder

“…1,2 In the present patient, US showed echogenic material within the gallbladder, and color-Doppler imaging demonstrated a persistent pulsatile flow within the echogenic lesion. These findings strongly suggested that the echogenic material could be a pseudoaneurysm in the gallbladder.…”

“…[1][2][3][4][5][6][7][8][9] However, pseudoaneurysm of the hepatic artery that ruptured into the gallbladder may be very rare, and in our survey of the literature, the present case report is the first case. The detailed mechanism of the pseudoaneurysm remains speculative.…”

“…Only nine cases have been reported in the English-language literature. [1][2][3][4][5][6][7][8][9] However, pseudoaneurysm of the hepatic artery associated with cholecystitis is very rare, and to the best our knowledge, no published cases have been reported previously. In this report, we describe a rare case of hepatic artery pseudoaneurysm associated with cholecystitis that ruptured into the gallbladder.…”

Cystic Artery Pseudoaneurysm: Over Warfarinisation and Management

“…Pseudoaneurysms of the cystic artery are rare possibly because early thrombosis of the cystic artery is considered to be a reaction of the inflammatory process [8]. However, the pseduoaneursym may have formed in our patient due to his over-anticoagulated state.…”

“…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].…”