Abstract:We report a case of hemobilia caused by pseudoaneurysm of the cystic artery in a 71-year-old woman who presented with fever and epigastric colicky pain with jaundice. Liver function tests showed signs of obstructive jaundice. On the second day, patient had a massive hematemesis and melena with hypovolemic shock. Hemobilia was diagnosed by endoscopically visualizing bleeding from the papilla of Vater. An emergent angiography demonstrated the presence of a pseudoaneurysm in the cystic artery. Selective embolizat… Show more
“…This, however, has a low sensitivity and is limited when visualising sub-centimetre lesions, with one series demonstrating a detection rate of only 27% 2 . Such was the case with our patient where ultrasound revealed a distended gallbladder with internal echogenicity but failed to identify the 12 mm pseudoaneurysm.…”
Section: Discussionmentioning
confidence: 56%
“…Cystic artery pseudoaneurysms remain a rare cause of upper gastrointestinal bleeding, with only twenty-two documented cases in the English literature. 1,2 They develop primarily as a consequence of adventitial damage and thrombosis of the vasa vasorum, resulting in damage to the muscular and elastic components of the media and intima with ensuing extravasation of arterial blood, progressive enlargement and eventual rupture, as governed by the Law of Laplace. 2–4,8 This can occur secondary to inflammatory conditions (e.g.…”
Section: Discussionmentioning
confidence: 99%
“…Formation may be further accelerated by patient factors, such as atherosclerosis, hypertension, bleeding disorders and vasculitis. 1–7 Cystic artery pseudoaneurysms tend to enlarge and erode into the gallbladder and adjacent biliary tree with approximately 45% bleeding into the biliary system (haemobilia). 9 The clinical presentation is that of biliary colic (70% of cases), obstructive jaundice (60%) and upper gastrointestinal bleeding (100%).…”
INTRODUCTION Cystic artery pseudoaneurysms and cholecystoenteric fistulae represent two rare complications of gallstone disease.PRESENTATION OF CASE An 86 year old male presented to the emergency department with obstructive jaundice, RUQ pain and subsequent upper gastrointestinal bleeding. Upper GI endoscopy revealed bleeding from the medial wall of the second part of the duodenum and a contrast-enhanced computed tomography scan revealed a cystic artery pseudoaneurysm, concurrent cholecystojejunal fistula and gallstone ileus. This patient was successfully managed surgically with open subtotal cholecystectomy, pseudoaneurysm resection and fistula repair.DISCUSSION To date there are very few cases describing haemobilia resulting from a bleeding cystic artery pseudoaneurysm. This report is the first to describe upper gastrointestinal bleeding as a consequence of two synchronous rare pathologies: a ruptured cystic artery pseudoaneurysm causing haemobilia and bleeding through a concurrent cholecystojejunal fistula.CONCLUSION Through this case, we stress the importance of accurate and early diagnosis through ultra- sonography, endoscopy, and contrast-enhanced CT imaging and emphasise that haemobilia should be included in the differential diagnosis of anyone presenting with upper gastrointestinal bleeding. We have demonstrated the success of surgical management alone in the treatment of such a case, but accept that consideration of combined therapeutic approach with angiography be given in the first instance, when available and clinically indicated.
“…This, however, has a low sensitivity and is limited when visualising sub-centimetre lesions, with one series demonstrating a detection rate of only 27% 2 . Such was the case with our patient where ultrasound revealed a distended gallbladder with internal echogenicity but failed to identify the 12 mm pseudoaneurysm.…”
Section: Discussionmentioning
confidence: 56%
“…Cystic artery pseudoaneurysms remain a rare cause of upper gastrointestinal bleeding, with only twenty-two documented cases in the English literature. 1,2 They develop primarily as a consequence of adventitial damage and thrombosis of the vasa vasorum, resulting in damage to the muscular and elastic components of the media and intima with ensuing extravasation of arterial blood, progressive enlargement and eventual rupture, as governed by the Law of Laplace. 2–4,8 This can occur secondary to inflammatory conditions (e.g.…”
Section: Discussionmentioning
confidence: 99%
“…Formation may be further accelerated by patient factors, such as atherosclerosis, hypertension, bleeding disorders and vasculitis. 1–7 Cystic artery pseudoaneurysms tend to enlarge and erode into the gallbladder and adjacent biliary tree with approximately 45% bleeding into the biliary system (haemobilia). 9 The clinical presentation is that of biliary colic (70% of cases), obstructive jaundice (60%) and upper gastrointestinal bleeding (100%).…”
INTRODUCTION Cystic artery pseudoaneurysms and cholecystoenteric fistulae represent two rare complications of gallstone disease.PRESENTATION OF CASE An 86 year old male presented to the emergency department with obstructive jaundice, RUQ pain and subsequent upper gastrointestinal bleeding. Upper GI endoscopy revealed bleeding from the medial wall of the second part of the duodenum and a contrast-enhanced computed tomography scan revealed a cystic artery pseudoaneurysm, concurrent cholecystojejunal fistula and gallstone ileus. This patient was successfully managed surgically with open subtotal cholecystectomy, pseudoaneurysm resection and fistula repair.DISCUSSION To date there are very few cases describing haemobilia resulting from a bleeding cystic artery pseudoaneurysm. This report is the first to describe upper gastrointestinal bleeding as a consequence of two synchronous rare pathologies: a ruptured cystic artery pseudoaneurysm causing haemobilia and bleeding through a concurrent cholecystojejunal fistula.CONCLUSION Through this case, we stress the importance of accurate and early diagnosis through ultra- sonography, endoscopy, and contrast-enhanced CT imaging and emphasise that haemobilia should be included in the differential diagnosis of anyone presenting with upper gastrointestinal bleeding. We have demonstrated the success of surgical management alone in the treatment of such a case, but accept that consideration of combined therapeutic approach with angiography be given in the first instance, when available and clinically indicated.
“…Severe hemorrhagic cholecystitis could also induce hypovolemic shock, which is associated with high mortality rate and requires emergent resuscitation [9] . Subsequently, successful transcatheter embolization was achieved with particles and coils since the patient was unfit for surgery [10] . Fig.…”
Hemorrhagic cholecystitis is a rare cause of abdominal pain that can have dire consequences. We report a case of hemorrhagic cholecystitis in a 51-year-old female presenting as shock and abdominal pain. The patient was transported to the emergency room. Ultrasound scan revealed hemoperitoneum and cholecystitis features. On computed tomography, mild gallbladder wall thickening and high density materials in the gallbladder suggested acute calculous cholecystitis, bleeding tumor, or hemorrhagic cholecystitis. An urgent cystic arterial embolization and percutaneous transhepatic drainage were done. After initial stablization, laparoscopic cholecystectomy was performed that revealed a necrotic gallbladder filled with large blood clots. It was important for timely management by having an early recognition of this potentially fatal condition.
“…Cystic artery pseudoaneurysms have been described secondary to trauma, inflammation, and vascular disease, with only 23 nontraumatic cases reported in the literature. [ 1 2 3 4 5 6 ] We report the diagnosis and transcatheter embolization of a cystic artery pseudoaneurysm caused by acute, ruptured cholecystitis, a previously undescribed etiology.…”
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