Pseudoaneurysm of the cystic artery secondary to cholecystitis as a cause of hemobilia: report of a case.
Spontaneous intracholecystic bleeding is very rare. We report herein a very rare case of a pseudoaneurysm of the cystic artery due to acute cholecystitis. A 58-year-old man presented at the emergency department complaining of colicky pain in the right upper quadrant. Dynamic magnetic resonance imaging demonstrated an early-enhanced pooling of contrast material (suggestive of a pseudoaneurysm of the cystic artery) inside the neck of the gallbladder. After the proximal control of the hepatic artery, the patient underwent a cholecystectomy and a ligation of the cystic artery. The resected specimen of the gallbladder showed evidence of a massive intracholecystic hematoma. Proximal to the impacted gallstone in the neck, a 2-cm diameter saccular-type pseudoaneurysm was identified. Although a pseudoaneurysm of the cystic artery is very rare, it should be included in the differential diagnosis of hemobilia. Once the pseudoaneurysm is confirmed, its embolization before a cholecystectomy (which can be attempted laparoscopically) may be useful to ensure the safety of the patient.
Akatsu
Tomotaka
T
Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
Tanabe
Minoru
M
Shimizu
Tomohiro
T
Handa
Kan
K
Kawachi
Shigeyuki
S
Aiura
Koichi
K
Ueda
Masakazu
M
Shimazu
Motohide
M
Kitajima
Masaki
M
D017541:Aneurysm, False / Q000150:complications / Q000209:etiology*; D002764:Cholecystitis / Q000150:complications*; D005704:Gallbladder / Q000098:blood supply* / Q000473:pathology; D006431:Hemobilia / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged