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Unruptured cystic artery pseudoaneurysm accompanied by Mirizzi syndrome: a report of a case

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Abstract

Pseudoaneurysm of the cystic artery is a rare complication of cholecystitis. 34 cases have been reported from 1976 to 2012, searched on MEDLINE and most of the cases have presented with gastrointestinal bleeding. We report the third case of an unruptured pseudoaneurysm of the cystic artery associated with calculous cholecystitis. An 85-year-old female presented to the emergency unit with epigastric pain and jaundice. Laboratory data and contrast-enhanced computed tomography (CT) revealed calculous cholecystitis and Mirizzi syndrome accompanied by a pseudoaneurysm in the gallbladder. Color Doppler ultrasonography (US) clearly demonstrated the pulsatile pseudoaneurysm. After biliary drainage and antimicrobial therapy, selective hepatic angiography with the aim of providing transcatheter arterial embolization was performed but the pseudoaneurysm had already thrombosed spontaneously. Open cholecystectomy was successfully carried out. Histological specimens demonstrated the pseudoaneurysm with organized thrombus in the epithelial wall of the gallbladder thickened with severe fibrosis. It is suggested that cholecystitis with unusual symptoms such as gastrointestinal bleeding requires immediate enhanced CT and US with Doppler imaging in order not to overlook a rare but life-threatening pseudoaneurysm.

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References

  1. Osada H, Ohno H, Watanabe W, Okada T, Nakada K, Honda H. Cystic artery bleeding due to blunt gallbladder injury: computed tomography findings and treatment with transcatheter arterial embolization. Jpn J Radiol. 2010;28(2):162–5.

    Article  PubMed  Google Scholar 

  2. Hanazaki K, Machida E, Sodeyama H, Asato S, Sode Y, Wakabayashi M, et al. Chronic cholecystitis following hemobilia due to traumatic intrahepatic injury. Surg Endosc. 1995;9(9):1004–7.

    Article  PubMed  CAS  Google Scholar 

  3. Moses V, Keshava SN, Wann VC, Joseph P, Sitaram V. Cystic artery pseudoaneurysm after laparoscopic cholecystectomy presenting as haemobilia: a case report. Trop Gastroenterol. 2008;2:107–9.

    Google Scholar 

  4. Srinivasaiah N, Bhojak M, Jackson R, Woodcock S. Vascular emergencies in cholelithiasis and cholecystectomy: our experience with two cases and literature review. Hepatobiliary Pancreat Dis Int. 2008;7(2):217–20.

    PubMed  Google Scholar 

  5. Madanur MA, Battula N, Sethi H, Deshpande R, Heaton N, Rela N. Pseudoaneurysm following laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int. 2007;6(3):294–8.

    PubMed  Google Scholar 

  6. Halbe S, Ahmed NI, Sundar K, Sathyakumar C. Pseudoaneurysm in gall bladder fossa following laparoscopic cholecystectomy. Indian J Gastroenterol. 1999;18(3):122.

    PubMed  CAS  Google Scholar 

  7. Bergey E, Einstein DM, Herts BR. Cystic artery pseudoaneurysm as a complication of laparoscopic cholecystectomy. Abdom Imaging. 1995;1:75–7.

    Article  Google Scholar 

  8. Hakami M, Beheshti Gh, Amirkhan A. Hemobilia caused by rupture of cystic artery aneurysm. Am J Proctol. 1976;27:56–7.

    PubMed  CAS  Google Scholar 

  9. Berland LL, Doust BD, Foley WD. Acute hemorrhage into the gallbladder diagnosed by computed tomography and ultrasonography. J Comput Assist Tomogr. 1980;4:260–2.

    Article  PubMed  CAS  Google Scholar 

  10. Reddy SC. Pseudoaneurysm of cystic artery with upper gastrointestinal hemorrhage. South Med J. 1983;76:85–6.

    Article  PubMed  CAS  Google Scholar 

  11. Sasaki F, Koga S, Takeuchi A. A case of hemorrhage from hepatic pseudoaneurysm due to cholelithiasis into the gallbladder (in Japanese with English abstract). Rinsho Hoshasen. 1983;28:407–10.

    PubMed  CAS  Google Scholar 

  12. Rhee JW, Bonnheim DC, Upson J. Cystic artery pseudoaneurysm, NY State. J Med. 1987;87:47.

    CAS  Google Scholar 

  13. Wu TC, Liu TJ, Ho YJ. Pseudoaneurysm of the cystic artery with upper gastrointestinal hemorrhage. Acta Chir Scand. 1988;154:151–2.

    PubMed  CAS  Google Scholar 

  14. Strickland SK, Khoury MB, Kiproff PM, Raves JJ. Cystic artery pseudoaneurysm: a rare cause of hemobilia. Cardiovasc Intervent Radiol. 1991;14:183–4.

    Article  PubMed  CAS  Google Scholar 

  15. Read A, Lannan M, Chou ST, Hennessy O. Bleeding cystic artery aneurysm: rare cause of hemobilia. Aust NZ J Surg. 1991;61:159–61.

    Article  CAS  Google Scholar 

  16. Barba CA, Bret PM, Hinchey EJ. Pseudoaneurysm of the cystic artery: a rare cause of hemobilia. Can J Surg. 1994;37:64–6.

    PubMed  CAS  Google Scholar 

  17. Nakajima M, Hoshino H, Hayashi E, Nagano K, Nishimura D, Katada N, et al. Pseudoaneurysm of the cystic artery associated with upper gastrointestinal bleeding. J Gastroenterol. 1996;31:750–4.

    Article  PubMed  CAS  Google Scholar 

  18. Maw A, Mander BJ, Nandi SC, Taube M, Evans HJR. Pseudoaneurysm of the cystic artery. Eur J Surg. 1997;163:307–9.

    PubMed  CAS  Google Scholar 

  19. Kaman L, Kumar S, Behera A, Katariya RN. Pseudoaneurysm of the cystic artery: a rare cause of hemobilia. Am J Gastroenterol. 1998;93:1535–7.

    Article  PubMed  CAS  Google Scholar 

  20. England RE, Marsh PJ, Ashleigh R, Martin DF. Case report: pseudoaneurysm of the cystic artery: a rare cause of haemobilia. Clin Radiol. 1998;53:72–5.

    Article  PubMed  CAS  Google Scholar 

  21. Delgadillo X, Berney T, Perrot MD, Didier D, Morel P. Successful treatment of a pseudoaneruysm of the cystic artery with microcoil embolization. J Vasc Interv Radiol. 1999;10:789–92.

    Article  PubMed  CAS  Google Scholar 

  22. Maeda A, Kunou T, Saeki S, Aono K, Murata T, Niinomi N. Pseudoaneusysm of the cystic artery with hemobilia treated by arterial embolization and elective cholecystectomy. J Hepatobiliary Pancreat Surg. 2002;9:755–8.

    Article  PubMed  Google Scholar 

  23. Akatsu T, Hayashi S, Egawa T, Doi M, Nagashima A, Kitano M, et al. Hepatic artery pseudoaneurysm associated with cholecystitis that ruptured into the gallbladder. J Gastroenterol. 2004;39:900–3.

    Article  PubMed  Google Scholar 

  24. Morioka D, Ueda M, Baba N, Kubota K, Otsuka Y, Akiyama H, et al. Hemobilia caused by pseudoaneurysm of the cystic artery. J Gastroenterol Hepatol. 2004;19:724–6.

    Article  PubMed  Google Scholar 

  25. Gutiérrez G, Ramia JM, Villar J, Garrote D, Ferron A, Ruiz E. Cystic artery pseudoaneurysm from an evolved acute calculous cholecystitis. Am J Surg. 2004;187:519–20.

    Article  PubMed  Google Scholar 

  26. Sibulesky L, Ridlen M, Pricolo VE. Hemobilia due to cystic artery pseudoaneurysm. Am J Surg. 2006;191:797–8.

    Article  PubMed  Google Scholar 

  27. Pérez-Castrillon JL, Mendo M, Calero H. Hemorrhage into the gallbladder caused by pseudoaneurysm of the cystic artery. Endoscopy. 2006;38:E50.

    Article  PubMed  Google Scholar 

  28. Lee JW, Kim MY, Kim YJ, Suh CH. CT of acute lower GI bleeding in chronic cholecystitis: concomitant pseudoaneruysm of cystic artery and cholecystocolonic fistula. Clin Radiol. 2006;61:634–6.

    Article  PubMed  CAS  Google Scholar 

  29. Akatsu T, Tanabe M, Shimizu T, Handa K, Kawachi S, Aiura K, et al. Pseudoaneurysm of the cystic artery secondary to cholecystitis as a cause of hemobilia: report of a case. Surg Today. 2007;37:412–7.

    Article  PubMed  Google Scholar 

  30. Ghoz A, Kheir E, Kotru A, Halazun K, Kessel D, Patel JJ, et al. Hemoperitoneum secondary to rupture of cystic artery pseudoaneurysm. Hepatobiliary Pancreat Dis Int. 2007;6(3):321–3.

    PubMed  Google Scholar 

  31. Saluja SS, Ray S, Gulati MS, Pal S, Sahni P, Chattopadhyay TK. Acute cholecystitis with massive upper gastrointestinal bleed: a case report and review of the literature. BMC Gastroenterol. 2007;7:12.

    Article  PubMed  Google Scholar 

  32. Machida H, Ueno E, Shiozawa S, Fujimura M, Tsuchiya A, Kim DH, et al. Unruptured pseudoaneurysm of the cystic artery with acute calculous cholecystitis incidentally detected by computed tomography. Radiat Med. 2008;26:384–7.

    Article  PubMed  Google Scholar 

  33. Shimada K, Sakamoto Y, Esaki M, Kosuge T. Pseudoaneurysm of the cystic artery associated with xanthogranulomatous cholecystitis. Dig Surg. 2008;25:8–9.

    Article  PubMed  Google Scholar 

  34. Mullen R, Suttie SA, Bhat R, Evgenikos N, Yalamarthi S, McBride KD. Microcoil embolisation of mycotic cystic artery pseudoaneurysm: a viable option in high-risk patients. Cardiovasc Intervent Radiol. 2009;32:1275–9.

    Article  PubMed  Google Scholar 

  35. Sousa HT, Amaro P, Brito J, Almeida J, Silva MR, Romãozinho JM. Hemobilia due to pseudoaneurysm of the cystic artery. Gastroenterol Clin Biol. 2009;33:80–7.

    Article  PubMed  CAS  Google Scholar 

  36. Lin YH, Lee RC, Hsia CY, Chen HC, Chiang JH, Tseng HS, et al. Right hepatic artery pseudoaneurysm ruptured into the gallbladder demonstrated by magnetic resonance angiography. J Chin Med Assoc. 2010;73:331–3.

    Article  PubMed  Google Scholar 

  37. Ahmed I, Tanveer UH, Sajjad Z, Bunazza B, Azeem UD, Basit S. Cystic artery pseudo-aneurysm: a complication of xanthogranulomatous cholecystitis. Br J Radiol. 2010;83:e165–7.

    Article  PubMed  CAS  Google Scholar 

  38. Hague J, Brennand D, Raja J, Amin Z. Cystic artery pseudoaneurysm in hemorrhagic acute cholecystitis. Cardiovasc Intervent Radiol. 2010;33:1287–90.

    Article  PubMed  Google Scholar 

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Disclosures

Conflict of interest: The authors declare that they have no conflict of interest.

Human/animal rights: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed consent: Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Asahikawa City Hospital, 1-65, Kinseicho 1-chome, Asahikawa, Hokkaido, Japan

    Satoshi Suzuki, Yusuke Saito, Kazumasa Nakamura, Ryuji Sukegawa, Atsushi Chiba, Shunsuke Nakajima, Ryuji Sugiyama, Kenichiro Ozawa, Masaki Taruishi & Akio Takada

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  1. Satoshi Suzuki
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  2. Yusuke Saito
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  3. Kazumasa Nakamura
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Correspondence to Satoshi Suzuki.

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Suzuki, S., Saito, Y., Nakamura, K. et al. Unruptured cystic artery pseudoaneurysm accompanied by Mirizzi syndrome: a report of a case . Clin J Gastroenterol 6, 490–495 (2013). https://doi.org/10.1007/s12328-013-0434-6

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  • DOI: https://doi.org/10.1007/s12328-013-0434-6

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