Cystic Artery Pseudoaneurysm: A Rare Cause to Obscure Upper Gastrointestinal Bleeding

Abstract

Obscure gastrointestinal bleeding is a surgical enigma of disastrous proportions. Patient’s haemodynamic status often dictates the path of management ranging from endoscopy, embolization and/or surgery. Minority of the cases has failed to identify the exact source of bleeding during endoscopic and imaging techniques. Emergency surgery is warranted in hypovolaemic shock which has failed to respond to fluid and blood resuscitation. We present a 72-year-old male with an obscure upper gastrointestinal bleeding due to ruptured cystic artery pseudoaneurysm and illustrate the rarity of the presentation with successful management.

A rare cause of upper gastrointestinal bleed

“…The gold standard option for cystic artery pseudoaneurysms is endovascular intervention however in scenarios where the diagnosis is not clear an operative approach with cholecystectomy is a safe management option. 6 This is a rare case of recurrence, intermittent UGI bleeding. We would recommend that a CT angiogram be performed in patients that have chronic cholecystitis to rule out the presence of a cholecystoduodenal fistula as a cause of the bleeding.…”

“…In this case the authors believe the chronic inflammation is likely to have resulted in the formation of the pseudoaneurysm. The gold standard option for cystic artery pseudoaneurysms is endovascular intervention however in scenarios where the diagnosis is not clear an operative approach with cholecystectomy is a safe management option 6 …”