Laparoscopic management of a cystic artery pseudoaneurysm in a patient with calculus cholecystitis.
BACKGROUND
Pseudoaneurysm of the cystic artery is very rare. In the majority of cases it has been reported as a post-operative complication of laparoscopic cholecystectomy, however it has also been associated with the presence of acute cholecystitis or pancreatitis. When these pseudoaneurysms rupture they can lead to intraperitoneal bleeding, haemobilia and upper gastrointestinal haemorrhage. Radiological as well as open surgical approaches have been described for control of this rare pathology.


METHODS
We report the laparoscopic surgical management of an incidental, unruptured cystic artery pseudoaneurysm in a patient presenting with acute cholecystitis.


CONCLUSIONS
Cystic artery pseudoaneurysm is a rare entity and as such there is no consensus on the clinical management of this condition. A variety of treatment strategies have been reported in the literature including radiological selective embolisation and coiling, open cholecystectomy with ligation of the aneurysm, or a two-step approach involving radiological management of the pseudoaneurysm followed by an elective cholecystectomy.


CONCLUSIONS
In this report we have demonstrated that laparoscopic management of a cystic artery pseudoaneurysm with simultaneous laparoscopic cholecystectomy is feasible and safe. This avoids multiple invasive procedures and decreases morbidity associated with open surgery.
Department of Upper Gastrointestinal Surgery, Ashford and St Peters NHS Trust, UK.
Sofronis
S
Loizides
Department of Upper Gastrointestinal Surgery, Ashford and St Peters NHS Trust, UK. Electronic address: asadc2k@gmail.com.
Asad
A
Ali
Department of Upper Gastrointestinal Surgery, Ashford and St Peters NHS Trust, UK.
Richard
R
Newton
Department of Upper Gastrointestinal Surgery, Worthing Hospital, Western Sussex NHS Trust, Worthing, UK.
Krishna Kumar
KK
Singh
Calculus cholecystitis; Cystic artery; Laparoscopic; Pseudoaneurysm