title: Pseudoaneurysm of the cystic artery secondary to cholecystitis as a cause of hemobilia: report of a case.
abstract: 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.
authors.affiliation: Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Akatsu
authors.forename: Minoru
authors.initials: M
authors.lastname: Tanabe
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Shimizu
authors.forename: Kan
authors.initials: K
authors.lastname: Handa
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Kawachi
authors.forename: Koichi
authors.initials: K
authors.lastname: Aiura
authors.forename: Masakazu
authors.initials: M
authors.lastname: Ueda
authors.forename: Motohide
authors.initials: M
authors.lastname: Shimazu
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajima
mesh_terms: 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