Unruptured cystic artery pseudoaneurysm accompanied by Mirizzi syndrome: a report of a case

Abstract

Pseudoaneurysm of the cystic artery is a rare complication of cholecystitis. 34 cases have been reported from 1976 to 2012, searched on MEDLINE and most of the cases have presented with gastrointestinal bleeding. We report the third case of an unruptured pseudoaneurysm of the cystic artery associated with calculous cholecystitis. An 85-year-old female presented to the emergency unit with epigastric pain and jaundice. Laboratory data and contrast-enhanced computed tomography (CT) revealed calculous cholecystitis and Mirizzi syndrome accompanied by a pseudoaneurysm in the gallbladder. Color Doppler ultrasonography (US) clearly demonstrated the pulsatile pseudoaneurysm. After biliary drainage and antimicrobial therapy, selective hepatic angiography with the aim of providing transcatheter arterial embolization was performed but the pseudoaneurysm had already thrombosed spontaneously. Open cholecystectomy was successfully carried out. Histological specimens demonstrated the pseudoaneurysm with organized thrombus in the epithelial wall of the gallbladder thickened with severe fibrosis. It is suggested that cholecystitis with unusual symptoms such as gastrointestinal bleeding requires immediate enhanced CT and US with Doppler imaging in order not to overlook a rare but life-threatening pseudoaneurysm.

A case of Mirizzi syndrome accompanied by a pseudoaneurysm that ruptured into the gallbladder: successfully treated by embolization of aneurysm and sequential surgery

“…The curative treatment for cholecystitis and Mirizzi syndrome complicated by hemobilia and hepatic aneurysm, such as in this case, is basically cholecystectomy because of the possibility of recurrent hemorrhage and carcinoma development [ 11 – 14 ]. It has recently been reported that TAE is minimally invasive, can be performed following angiographic diagnosis, and that control of bleeding by TAE is accomplished prior to radical surgery [ 15 – 17 ].…”

“…In the present case, we considered the possibility of worsening of inflammation and necrosis of the gallbladder due to gallbladder infarction, rebleeding due to persistent inflammation, and severe cholangitis due to hematoma in the bile duct; consequently, we performed emergency surgery on the same day. Although surgery is the first choice for Mirizzi syndrome, TAE has been reported to be effective for aneurysms associated with hemobilia [ 15 – 17 ]. And in this case, we performed cholecystectomy after TAE.…”

Haemobilia due to a ruptured right hepatic pseudoaneurysm secondary to Mirizzi syndrome with simultaneous cholecystoduodenal fistula

“…Imaging in the form of ultrasound with colour doppler, CT angiography or dynamic magnetic resonance imaging can be used to make the diagnosis. Selective hepatic arterial angiography provides both a diagnostic and therapeutic option 1,3 . This is the preferred method of treatment prior to an operation to avoid bleeding during cholecystectomy 3 …”

“…Selective hepatic arterial angiography provides both a diagnostic and therapeutic option. 1,3 This is the preferred method of treatment prior to an operation to avoid bleeding during cholecystectomy. 3 To the authors' knowledge, this is the first case described in the literature of Mirizzi syndrome and right hepatic artery pseudoaneurysm with concurrent cholecystoduodenal fistula.…”

“…1,3 This is the preferred method of treatment prior to an operation to avoid bleeding during cholecystectomy. 3 To the authors' knowledge, this is the first case described in the literature of Mirizzi syndrome and right hepatic artery pseudoaneurysm with concurrent cholecystoduodenal fistula. This case highlights the importance of considering a pseudoaneurysm in patients presenting with gallstone disease and upper gastrointestinal bleeding.…”