title: Fistula between cystic artery pseudoaneurysm and cystic bile duct cause of acute anemia one year after laparoscopic cholecystectomy.
abstract: 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.
authors.affiliation: Department of Surgery, Ludwig-Maximilians-University, Munich, Germany. Jens.Heyn@med.uni-muenchen.de
authors.forename: Jens
authors.initials: J
authors.lastname: Heyn
authors.forename: Sandra
authors.initials: S
authors.lastname: Sommerey
authors.forename: Rupert
authors.initials: R
authors.lastname: Schmid
authors.forename: Klaus
authors.initials: K
authors.lastname: Hallfeldt
authors.forename: Stefan
authors.initials: S
authors.lastname: Schmidbauer
mesh_terms: 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*