Fistula between cystic artery pseudoaneurysm and cystic bile duct cause of acute anemia one year after laparoscopic cholecystectomy.
We present a case of hemorrhage from a cystic artery pseudoaneurysm one year after laparoscopic cholecystectomy. A 78-year-old male with a history of recurrent melena, hematemesis, and right upper abdominal pain was admitted to our emergency department. His blood pressure was 60/30 mm Hg with a pulse rate of 100 beats per minute. Hemoglobin was 7.6 g/dL and white blood cell count 19500/mm(3). Computed tomography scan of the abdomen and selective digital subtraction arteriography showed a pseudoaneurysm in the region of the former bed of the gallbladder. During gastroscopy, a pulsatile bleeding out of the papilla of Vater was found. Surgery by the open approach confirmed the presence of a cystic artery pseudoaneurysm and showed an additional fistula between the pseudoaneurysm and the cystic bile duct. Resection of the pseudoaneurysm and revision of the common bile duct with implantation of a T-tube was performed. The patient recovered well and was discharged from our hospital three weeks after surgery.
Heyn
Jens
J
Department of Surgery, Ludwig-Maximilians-University, Munich, Germany. Jens.Heyn@med.uni-muenchen.de
Sommerey
Sandra
S
Schmid
Rupert
R
Hallfeldt
Klaus
K
Schmidbauer
Stefan
S
D000368:Aged; D000740:Anemia / Q000209:etiology; D017541:Aneurysm, False / Q000209:etiology*; D001649:Bile Duct Diseases / Q000209:etiology*; D001658:Biliary Fistula / Q000209:etiology*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003549:Cystic Duct / Q000098:blood supply*; D006801:Humans; D008297:Male; D013997:Time Factors; D016157:Vascular Fistula / Q000209:etiology*