Successful Transcatheter Arterial Embolisation of a Cystic Artery Pseudoaneurysm Secondary to Calculus Cholecystitis: A Case Report

Abstract

Pseudoaneurysms of the cystic artery secondary to calculus cholecystitis are rare. In this report we describe a case of an elderly female who presented with abdominal pain, pyrexia, anaemia and jaundice. She had known chronic cholecystitis, but was not considered a suitable surgical candidate. Contrast enhanced computed tomography (CECT) demonstrated a probable aneurysm within the gallbladder fossa. The patient proceeded to digital subtraction angiography (DSA), which confirmed an aneurysm arising from the cystic artery and was subsequently managed with transcatheter arterial embolisation using coils. This case report reviews the diagnosis and management of this rare complication.

Case report: cystic artery pseudoaneurysm presenting as a massive per rectum bleed treated with percutaneous coil embolization

“…Percutaneous selective cystic artery embolization is shown to be an effective treatment strategy in these patients in the acute setting with less mortality and morbidity than surgery with better identification of the bleeding vessel and higher rates of achieving haemorrhagic control (Lygidakis et al 1991) Options for embolization include coils, glue injection or Gelfoam (Pfizer) injection. Coil embolization is the favoured technique as coils can be used to treat a variety of vessel sizes and can be introduced without the risk of increasing the pressure in this vascular lesion, which may be a risk with the injected embolic agents such as glue or Gelfoam (Desai and et al 2010). Cystic artery embolisation has been shown to be a safe procedure.…”

Cystic Artery Pseudoaneurysm: Over Warfarinisation and Management

“…Cystic artery pseudoaneurysm can be complication of cholecystitis, cholelithiasis or cholecystectomy induced mechanical or thermal injury [3,4]. They manifest as haemobilia when they rupture into the biliary tree.…”

“…Transcatheter embolization can be performed using several types of material, such as synthetic occlusive emulsions, gelatin sponges or other particles, or metallic microcoils [4]. Super-selective catheterization of an artery and release of microcoils causes the vessel to thrombose and allows control of bleeding [2].…”

Laparoscopic management of a cystic artery pseudoaneurysm in a patient with calculus cholecystitis

“…Pseudoaneurysms secondary to acute or chronic calculous cholecystitis are rare despite the high incidence of cholecystitis. To the best of our knowledge less than 25 such cases have been reported in the literature [2–25] .…”