Rupture of Cystic Artery Pseudoaneurysm: a Rare Complication of Acute Cholecystitis

Rupture of Cystic Artery Pseudoaneurysm: a Rare Complication of Acute Cholecystitis

Pseudoaneurysm (PA) of the cystic artery is rare. Most of the reported cases are iatrogenic and develop secondary to liver biopsy, laparoscopic cholecystectomy, ERCP, and liver transplant. Other reported causes include trauma, malignancy, arteriovenous malformations, and inflammation in the hepatobi...

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Bibliographic Details
Published in:Indian journal of surgery Vol. 80; no. 1; pp. 87 - 89
Main Authors: Praveen Kumar Sunkara, P. R. V., Shah, Parth Ketankumar, Rakshit, Kamalesh, Choudhary, Shuvro Roy, Bohidar, N. P., Dubey, Sanjay Kumar
Format: Journal Article
Language:English
Published: New Delhi Springer India 01-02-2018
Springer
Springer Nature B.V
Subjects:
Abdomen
Bile
Cardiac Surgery
Case Report
Cholecystectomy
Cholecystitis
Gallbladder diseases
Health aspects
Hemorrhagic shock
Inflammation
Laparoscopy
Liver
Liver transplantation
Medical imaging
Medicine
Medicine & Public Health
Neurosurgery
Pediatric Surgery
Plastic Surgery
Surgery
Thoracic Surgery
Embolization
Laparoscopic cholecystectomy
Cystic artery
Pseudoaneurysm
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Summary:Pseudoaneurysm (PA) of the cystic artery is rare. Most of the reported cases are iatrogenic and develop secondary to liver biopsy, laparoscopic cholecystectomy, ERCP, and liver transplant. Other reported causes include trauma, malignancy, arteriovenous malformations, and inflammation in the hepatobiliary and pancreatic system. Cystic artery psuedoaneurysm is usually asymptomatic but may also present as vague abdominal pain, intra-abdominal mass, and hemobilia. In the event of rupture, it may present as a catastrophic intra-peritoneal bleeding with hemorrhagic shock. Doppler ultrasound and contrast-enhanced CT scan are useful tools for the diagnosis of this condition. However, selective visceral angiography is confirmatory and offers the opportunity for therapeutic embolization. We report a case which presented with upper right quadrant abdominal pain, vomiting, and hypotension. Abdominal ultrasonography revealed subhepatic hematoma and pericholecystic fluid collection along with acute calculus cholecystitis and sludge in the bile duct. Subsequent contrast-enhanced CT and CT angiography confirmed the presence of ruptured cystic artery psuedoaneurysm with subhepatic hematoma. The patient after resuscitation underwent selective visceral angiography and successful coil embolization of the cystic artery pseudoaneurysm. During the same admission, ERCP and biliary stenting were also performed followed by laparoscopic cholecystectomy. This case reports a rare entity which was successfully treated using a multimodality strategy.
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ISSN:0972-2068
0973-9793
DOI:10.1007/s12262-017-1667-2