Cystic artery pseudoaneurysm secondary to acute cholecystitis: an unusual cause for haemobilia

Abstract

Pseudoaneurysm of the cystic artery is a rarely described cause of haemobilia. We report the unusual presentation of upper gastrointestinal haemorrhage due to a pseudoaneurysm of the cystic artery secondary to acute cholecystitis that was complicated by gallbladder perforation and liver abscess in an 88-year-old male. The original CT scan had demonstrated a high density focus in the gallbladder neck that was thought to represent a calculus. Selective embolization of the cystic artery resulted in cessation of the haemorrhage. Owing to the patient’s frailty and comorbidities, he was not considered suitable for cholecystectomy. The case emphasizes the need for a high level of awareness of pseudoaneurysmal disease in association with inflammatory conditions.

A pseudoaneurysm of the right hepatic artery treated successfully with a stent graft – A case report

“…Inappropriate use of thermal or mechanical energy during dissection of Calot’s triangle has been described as a possible explanation [ 9 , 10 ]. Another pathophysiologic process that has been described is the inflammation process in cholecystitis causing pseudoaneurysms to form [ 11 , 12 ]. In this case-report it is likely that the cholecystitis caused the formation of a pseudoaneurysm, considering the finding of a highly inflamed gallbladder during surgery.…”

Cystic Artery Hemorrhage after Cholecystostomy Catheter Exchange Treated with Transcatheter Embolization

“…Pseudoaneurysms of the cystic artery are an uncommonly reported entity. 2,3,5 Although the pathogenesis of formation of cystic artery aneurysm is not well understood, it is postulated that the inflammatory process associated with cholecystitis results in erosion of the cystic artery wall. 2,4 Despite the high incidence of acute and chronic cholecystitis, cystic artery pseudoaneurysms are rarely observed, as the same inflammatory process may also promote vessel thrombosis.…”

“…2,3,5 Although the pathogenesis of formation of cystic artery aneurysm is not well understood, it is postulated that the inflammatory process associated with cholecystitis results in erosion of the cystic artery wall. 2,4 Despite the high incidence of acute and chronic cholecystitis, cystic artery pseudoaneurysms are rarely observed, as the same inflammatory process may also promote vessel thrombosis. 2,3 In the presented case, dual-antiplatelet therapy may have prevented vessel thrombosis allowing for the formation of a pseudoaneurysm and clinically significant hemorrhage.…”

“…2,4 Despite the high incidence of acute and chronic cholecystitis, cystic artery pseudoaneurysms are rarely observed, as the same inflammatory process may also promote vessel thrombosis. 2,3 In the presented case, dual-antiplatelet therapy may have prevented vessel thrombosis allowing for the formation of a pseudoaneurysm and clinically significant hemorrhage.…”

“…[1][2][3] The pathogenesis of formation of cystic artery pseudoaneurysms is not well understood, but is thought to result from erosion of the cystic artery wall from the adjacent inflammatory process associated with acute or chronic cholecystitis. 2,4 The presented case discusses an incident of hemorrhage from a cystic artery pseudoaneurysm resulting in a large perihepatic hematoma as well as hemobilia, which developed after a routine cholecystostomy catheter exchange. This was treated with transcatheter embolization using ethylene-vinyl alcohol copolymer, commonly known as Onyx (Medtronic, Irvine, CA).…”