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Khawjah A, Khair MM, Goubran R. An unusual case of acute cholecystitis complicated by haemobilia and Mirizzi-like obstruction: a case report and review of literature. Ann Med Surg (Lond) 2024; 86:3646-3651. [PMID: 38846883 PMCID: PMC11152821 DOI: 10.1097/ms9.0000000000002038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/28/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction Cystic artery pseudoaneurysm rupture presents a rare yet potentially fatal aetiology for upper gastrointestinal (GI) bleed. While uncommon, its incidence has been rising with increased hepatobiliary surgical interventions, predominantly attributed to iatrogenic injury and rarely secondary to acute cholecystitis. Clinical manifestations typically include epigastric pain, upper GI haemorrhage, and obstructive jaundice. Due to its rarity, it is often excluded from initial differential diagnoses. Case report This is an unusual case of a 54-year-old male who presented with acute cholecystitis complicated by haemobilia and Mirizzi-like obstruction, in the setting of cystic artery pseudoaneurysm rupture. Initially, urgent transcatheter angiographic embolization of the cystic artery was performed to achieve hemodynamic stability. However, a triphasic computed tomography (CT) scan revealed the first attempt was unsuccessful, necessitating a second embolization. Subsequent imaging confirmed satisfactory embolization; however, a small area of liver necrosis was observed adjacent to the gallbladder. The patient was stable at discharge from the hospital and had an uncomplicated interval cholecystectomy. Discussion This case highlights the complexity and challenges associated with diagnosing and managing cystic artery pseudoaneurysm rupture. Diagnosis often relies on arterial phase contrast-enhanced CT scan. While no guideline currently exist, management typically involves achieving hemodynamic stability through Transcatheter angiographic embolization, followed by interval cholecystectomy. Conclusion Early recognition and intervention are crucial in managing cystic artery pseudoaneurysm rupture to prevent life-threatening haemorrhagic shock. Clinicians need to consider this rare condition in patients with upper GI bleeding and abnormal liver function tests.
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Affiliation(s)
- Ahmed Khawjah
- Letterkenny University Hospital, Letterkenny, Co. Donegal
| | | | - R. Goubran
- Galway University Hospital, Co. Galway, Ireland
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Itagaki Y, Yamamoto K, Kikuchi T, Takano H, Nishigami K, Fukunaga A, Ichimura T, Manase H, Hirano S. Laparoscopic cholecystectomy after transcatheter arterial embolisation for haemobilia due to a pseudoaneurysm in the gallbladder: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231166777. [PMID: 37122424 PMCID: PMC10134114 DOI: 10.1177/2050313x231166777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
Pseudoaneurysms of the cystic artery are a rare but significant complication of acute cholecystitis. Laparoscopic cholecystectomy may be a safe alternative to open cholecystectomy in such cases. We report the case of a female patient in her seventies, who presented with anaemia, jaundice, and hepatic dysfunction during hospitalisation for right knee pyogenic arthritis. The patient had no pain in the right upper quadrant. Her serum haemoglobin level was 6.5 g/dL, and upper gastrointestinal endoscopy revealed no abnormalities. Six days later, jaundice worsened, and endoscopic retrograde cholangiopancreatography revealed bloody bile. An endoscopic biliary drainage tube was inserted at the discretion of the gastroenterology department. Contrast-enhanced computed tomography revealed a haematoma in the gallbladder and a pseudoaneurysm in the lateral wall of the gallbladder. On the same day, the endoscopic biliary drainage tube was replaced with an endoscopic nasobiliary drainage tube, which indicated the degree of haemorrhage and enabled lavage of the lumen in cases of obstruction. The next day, angiography revealed a pseudoaneurysm of the deep branch of the cystic artery and coil embolisation was performed at the periphery of the cystic artery. Uninterrupted laparoscopic cholecystectomy was performed. Although laparoscopic cholecystectomy is difficult when bleeding is uncontrolled, it was safely performed following haemostasis using transcatheter arterial embolisation. Laparoscopic cholecystectomy is feasible in haemodynamically stable patients with cystic artery pseudoaneurysms after transcatheter arterial embolisation.
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Affiliation(s)
- Yuki Itagaki
- Department of Surgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Yuki Itagaki, Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, North 15 West 7, Kita-ku, Sapporo 0608638, Hokkaido, Japan.
| | - Kazuyuki Yamamoto
- Department of Surgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | - Tomoki Kikuchi
- Department of Surgical Pathology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | - Hironobu Takano
- Department of Surgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Kohei Nishigami
- Department of Surgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | - Akira Fukunaga
- Department of Thoracic Surgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | | | - Hiroto Manase
- Department of Surgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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Ng ZQ, Pradhan S, Cheah K, Wijesuriya R. Haemorrhagic cholecystitis: a rare entity not to be forgotten. BMJ Case Rep 2018; 2018:bcr-2018-226469. [PMID: 30244228 DOI: 10.1136/bcr-2018-226469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Haemorrhagic cholecystitis is a rare entity of acute cholecystitis that carries a high morbidity and mortality rate if management is delayed. Its clinical course can mirror that of acute cholecystitis. Characteristic findings on ultrasound or CT scan are useful clues to early diagnosis. Urgent cholecystectomy is required prior to progressing to perforation of gallbladder. Most of the literature are case reports with causes associated with anticoagulation. Herein, we described a morbidly obese patient with poorly controlled diabetes presenting with non-specific right upper quadrant pain and was subsequently diagnosed with haemorrhagic cholecystitis. A review of the literature was also performed to summarise the potential clinical presentations, distinctive imaging findings and management options available for this rare condition.
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Affiliation(s)
- Zi Qin Ng
- Royal Perth Hospital, Perth, Australia.,Department of General Surgery, St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
| | - Sharin Pradhan
- Department of General Surgery, St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
| | - Kim Cheah
- Australian Clinical Labs, St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
| | - Ruwan Wijesuriya
- Department of General Surgery, St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
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Fujimoto Y, Tomimaru Y, Hatano H, Noguchi K, Nagase H, Hamabe A, Hirota M, Oshima K, Tanida T, Morita S, Imamura H, Iwazawa T, Akagi K, Dono K. Ruptured Cystic Artery Pseudoaneurysm Successfully Treated with Urgent Cholecystectomy: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:187-193. [PMID: 29459583 PMCID: PMC5829622 DOI: 10.12659/ajcr.907273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Patient: Male, 90 Final Diagnosis: Ruptured cystic artery pseudoaneurysm Symptoms: Epigastric pain • Fever Medication: — Clinical Procedure: Open cholecystectomy Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Yuji Fujimoto
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Yoshito Tomimaru
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Hisanori Hatano
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan.,Department of Surgery, Rinku General Medical Center, Izumisano, Osaka, Japan
| | - Kozo Noguchi
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Hirotsugu Nagase
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Atsushi Hamabe
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Masashi Hirota
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Kazuteru Oshima
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Tsukasa Tanida
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Shunji Morita
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Takashi Iwazawa
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Kenzo Akagi
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Keizo Dono
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
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Kim DH, Kim TH, Kim CW, Chang JH, Han SW, Kim JK, Lee SH, Kim J. A Ruptured Cystic Artery Pseudoaneurysm with Concurrent Cholecystoduodenal Fistula: A Case Report and Literature Review. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2018. [DOI: 10.7704/kjhugr.2018.18.2.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Dong Hwi Kim
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Tae Ho Kim
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Chang Whan Kim
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Jae Hyuck Chang
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Sok Won Han
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Jae Kwang Kim
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Seung Hwan Lee
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Jeana Kim
- Department of Hospital Pathology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
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Trombatore C, Scilletta R, Bellavia N, Trombatore P, Magnano S Lio V, Petrillo G, Di Cataldo A. Acute hemobilia from a pseudoaneurysm of the cystic artery arising from the left hepatic artery: Case report and literature review. Int J Surg Case Rep 2017; 37:60-64. [PMID: 28641193 PMCID: PMC5479965 DOI: 10.1016/j.ijscr.2017.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/11/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Hemobilia represents only 6% of all causes of upper gastrointestinal bleeding. PRESENTATION OF CASE We report a rare case of a bleeding pseudoaneurysm of the cystic artery, due to a re-activation of a chronic cholecystitis, which arose with a mixed symptomatology: jaundices and hematemesis. DISCUSSION The rarity of our patient is increased for some vascular anatomic variations detected by Computed Tomography that influenced the management of the disease. Our patient was treated by endovascular embolization of the pseudoaneurysm and subsequent cholecystectomy. CONCLUSION About pseudoaneurysm of the cystic artery only few cases have been already reported and to date there are no guidelines for its management. We describe both diagnostic features and therapeutic strategies in comparison to the most recent literature.
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Affiliation(s)
- Claudia Trombatore
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy.
| | - Roberto Scilletta
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy.
| | - Noemi Bellavia
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy.
| | - Pietro Trombatore
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy.
| | | | - Giuseppe Petrillo
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy.
| | - Antonio Di Cataldo
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy.
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Hicks N. Haemorrhagic cholecystitis: an unusual cause of upper gastrointestinal bleeding. BMJ Case Rep 2014; 2014:bcr-2013-202437. [PMID: 24443336 DOI: 10.1136/bcr-2013-202437] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Haemorrhagic cholecystitis is a rare cause of upper gastrointestinal bleeding and is a difficult diagnosis to make. This case report describes an orthopaedic patient, who developed deranged liver function tests and anaemia after a hemiarthroplasty of the hip. The patient had upper abdominal pain and black stools which clinically appeared to be melaena. An ultrasound scan of the abdomen was inconclusive, and therefore a CT was performed and the potential diagnosis of haemorrhagic cholecystitis was raised. An endoscopic evaluation of the upper gastrointestinal tract showed no evidence of other causes of upper gastrointestinal bleeding. Following an emergency laparotomy and cholecystectomy, she recovered well. This report aims to increase awareness about the uncommon condition of haemorrhagic cholecystitis, and to educate regarding clinical and radiological signs which lead to this diagnosis.
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Affiliation(s)
- Natalie Hicks
- Department of Urology, James Paget University Hosptial, Great Yarmouth, Norfolk, UK
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