Laparoscopic treatment of an unruptured cystic artery pseudo-aneurysm in the presence of calculous emphysematous cholecystitis

Abstract

Cystic artery pseudoaneurysm is a rare complication of invasive biliary procedures or of acute or chronic cholecystitis and pancreatitis. Emphysematous cholecystitis is an acute inflammatory process of the gallbladder due to gas forming organisms such as Escherichia coli and Clostridium perfringens. We report the case of a 34-year-old gentleman admitted with a 3-day history of generalized abdominal pain, vomiting and markedly raised inflammatory markers. A computed tomography scan demonstrated acute calculus cholecystitis and an incidental CAP. This was successfully treated with an emergency laparoscopic cholecystectomy. CAPs are reported in the literature as rare and are usually diagnosed after rupture with severe haemorrhage. In this report, we highlight that a non-ruptured CAP identified preoperatively can be safely managed simultaneously with a laparoscopic approach, thus avoiding the need for invasive angiographic procedures or open surgery.

Cystic artery pseudo aneurysm in a patient with xanthogranulomatous cholecystitis: a multi-disciplinary approach towards management

“…3 In ruptured CAP, patients most commonly present with signs of shock and hemobilia, itself is noted to have a triad of symptoms, known as Quincke's triad, including jaundice, right upper quadrant pain and upper gastro intestinal haemorrhage. 4 Unruptered CAPs are very rare.…”