Spontaneous Cystic Artery Rupture: a Rare Cause of Haemoperitoneum

SUMMARYA 72-year-old man with a history of gallstones, and complex cardiac and endocrinological comorbidities, presented with severe abdominal pain and melaena. CT mesenteric angiogram showed a cystic artery pseudoaneurysm and gallbladder distended by haematoma. Subsequent mesenteric angiography confirmed a cystic artery pseudoaneurysm, which was successfully embolised with microcoils. The patient made a rapid recovery and was discharged after 3 days. BACKGROUND

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“…15 28 In these cases, surgical intervention was avoided either due to a presumed high risk of mortality or patient refusal.…”

Section: Discussionmentioning

confidence: 99%

Transarterial catheter embolisation for an unusual cause of upper gastrointestinal haemorrhage

et al. 2015

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“…In an earlier review 13 such cases were identified [14] thereafter we could identify 8 more reports [8,9,13-24]. Such aneurysms have been thought to occur subsequent to inflammatory processes in the vicinity of the vessel and can rupture into the gallbladder cystic duct or bile duct with resultant haemobilia or rarely rupture into the peritoneal cavity [17,25]. Exceptionally they may be incidentally detected in imaging studies [26].…”

Section: Discussionmentioning

confidence: 99%

Emergency cholecystectomy and hepatic arterial repair in a patient presenting with haemobilia and massive gastrointestinal haemorrhage due to a spontaneous cystic artery gallbladder fistula masquerading as a pseudoaneurysm

et al. 2013

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BackgroundHaemobilia usually occurs secondary to accidental or iatrogenic hepatobiliary trauma. It can occasionally present with cataclysmal upper gastrointestinal haemorrhage posing as a life threatening emergency. Haemobilia can very rarely be a complication of acute cholecystitis. Here we report a case of haemobilia manifesting as massive gastrointestinal haemorrhage in a patient without any prior history of biliary surgery or intervention and present a brief review of literature.Case presentationA 22 year old male admitted with history suggestive of acute cholecystitis subsequently developed waxing waning jaundice and recurrent episodes of upper gastrointestinal bleed. Endoscopy showed an ulcer in the first part of duodenum with a clot, no active bleed was visible. Angiography was suggestive of a ruptured pseudoaneurysm in the vicinity of the right hepatic artery probably originating from the cystic artery. Coil embolization was tried but the coil dislodged into the right branch of hepatic artery distal to the site of pseudoaneurysm. Review of angiographic video in light of operative findings demonstrated a fistulous communication between cystic artery and gallbladder as the cause, a simultaneous cholecystoduodenal fistula was also noted. Retrograde cholecystectomy, closure of cholecystoduodenal fistula and right hepatic arteriotomy with retrieval of the endo-coil and hepatic arterial repair was performed.ConclusionFistula between the cystic artery and gallbladder has been commonly reported to occur after laparoscopic cholecystectomy. Spontaneous fistulous communication, i.e. in the absence of any prior trauma or intervention, between cystic artery and gallbladder is rare with very few reports in literature. Aetiopathogenesis of the disease, in the context of current literature is reviewed. The diagnostic dilemma posed by the confounding finding of an ulcer in the duodenum, the iconic video angiographic depiction as also the therapeutic challenge of a failed embolization with consequent microcoil migration and primary hepatic arterial repair in the emergency situation is discussed.

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“…Some patients having typical obstructive jaundice and hemophilia may additionally need endoscopic retrograde cholangiopancreatography, CBD exploration or transhepatic biliary drainage to vacate the clot in the event the jaundice doesn't get relieved [49,52]. Natural or spontaneous rupture of normal cystic artery is undoubtedly an extremely exceptional reason behind hemoperitoneum [53]. Medical co-morbidity, for instance, arteriosclerosis, diabetes, arterial hypertension and long-term usage of corticosteroid are the most prevalent components liable for vascular fragility [53].…”

Section: Hemobilia Due To Cystic Artery Pseudoaneurysmmentioning

confidence: 99%

“…Natural or spontaneous rupture of normal cystic artery is undoubtedly an extremely exceptional reason behind hemoperitoneum [53]. Medical co-morbidity, for instance, arteriosclerosis, diabetes, arterial hypertension and long-term usage of corticosteroid are the most prevalent components liable for vascular fragility [53]. Selective embolization is an efficient and also a noninvasive treatment alternative, which can result in ischemic gallbladder necrosis few days following the treatment [53].…”

Section: Hemobilia Due To Cystic Artery Pseudoaneurysmmentioning

confidence: 99%

Cystic Artery Variations and Associated Vascular Complications in Laparoscopic Cholecystectomy

Prasoon¹,

Katada²,

Miura³

et al. 2020

Digestive System - Recent Advances

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Substantial knowledge of the arterial supply and its anatomical variations of the gall bladder and liver are important in all the hepatobiliary surgical procedures. The arterial supply of gallbladder called cystic artery (CA) is a vital structure required to get ligated or clipped in the path of laparoscopic cholecystectomy. The possible concerns like intra-operative bleeding or adjoining accidental injuries will almost always be focused on the research consisting of dissection and clipping with cystic artery. Pseudoaneurysm of the cystic artery has additionally been belonging to the presence of acute cholecystitis or pancreatitis. An original supply of CA is usually assessed depending on the existence of hepatic artery variants. Laparoscopic cholecystectomy is really a recent and arduous noninvasive procedure and might even result in substantial unintended effects possibly iatrogenic or in the form of post-procedural complications. The perfect knowledge of anatomy in addition to feasible variation of cystic artery is mandatory. An efficient operative strategy and consciousness are probably the key components with all the results and marginal likelihood of complications, which often can be ultimately attainable. Within this chapter, we have attempted to explore some variations of cystic artery, complications and management.

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Spontaneous Cystic Artery Rupture: a Rare Cause of Haemoperitoneum

Cited by 9 publications

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Transarterial catheter embolisation for an unusual cause of upper gastrointestinal haemorrhage

Transarterial catheter embolisation for an unusual cause of upper gastrointestinal haemorrhage

Emergency cholecystectomy and hepatic arterial repair in a patient presenting with haemobilia and massive gastrointestinal haemorrhage due to a spontaneous cystic artery gallbladder fistula masquerading as a pseudoaneurysm

Cystic Artery Variations and Associated Vascular Complications in Laparoscopic Cholecystectomy

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