Case report: cystic artery pseudoaneurysm presenting as a massive per rectum bleed treated with percutaneous coil embolization

Frank Carey,Kelvin Tan,Marcus Rault,Mark Lewis,Michael Crawford

doi:10.1186/s42155-019-0090-0

Frank Carey, Kelvin Tan + Show 3 more

Open Access

https://doi.org/10.1186/s42155-019-0090-0

Copy DOI

Abstract

BackgroundCystic artery pseudoaneurysms are rare. It usually occurs as a complication of laparoscopic cholecystectomy, but can arise uncommonly as a complication of acute cholecystitis. Ruptured cystic artery aneurysms present with haemobilia, intraperitoneal or upper gastrointestinal bleeding. We present an unusual case of cystic artery aneurysm presenting as a massive lower gastrointestinal bleed.Case presentationA 47-year-old man was admitted with a thoracic abscess and was noted incidentally on CT to have acute cholecystitis. Subsequently the patient then presented with massive fresh PR bleeding. This was found on CT to be the result of a cystic artery pseudoaneurysm with associated gallbladder fistulation to the hepatic flexure, secondary to cholecystitis. The patient was treated with coil embolisation of the cystic artery made a full recovery and was discharged with a view to performing an elective cholecystectomy.ConclusionCystic artery pseudoaneurysm is a rare complication of cholecystitis which can present as massive lower gastrointestinal haemorrhage secondary to cholecystocolic fistula. Percutaneous embolization is a safe and effective treatment in the acute phase.

Highlights

Cystic artery pseudoaneurysm is a rare occurrence, most often arising as a complication of biliary procedures
Cystic artery pseudoaneurysm is a rare complication of cholecystitis which can present as massive lower gastrointestinal haemorrhage secondary to cholecystocolic fistula
Clinical presentation is usually associated with rupture, which occurs in 45% of cases, leading to haemorrhagic cholecystitis, intraperitoneal bleeding and upper GI bleeding (Anand et al 2011)

Summary

Introduction

Cystic artery pseudoaneurysm is a rare occurrence, most often arising as a complication of biliary procedures. This is most commonly laparoscopic cholecystectomy (Kaman et al 1998), cases of ruptured cystic artery pseudoaneurysms have been described following endoscopic retrograde cholangiopancreatography (ERCP) (Proença et al 2019) Less commonly they can arise as a consequence of acute cholecystitis (Nkwam and Heppenstall 2010), in patients with polyarteritis nodosa (Saluja et al 2007), and abdominal trauma (Anand et al 2011). Case report A 47-year-old man was admitted to hospital with a 9 day history of abdominal pain and diarrhoea and an incidental fluctuant swelling on his back He had a previous medical history of alcoholic liver cirrhosis, anaemia and hypothyroidism. The patient was transferred to IRU where DSA confirmed the cystic artery pseudoaneurysm (Fig. 4). The patient was stepped down to the ward 2 days later and discharged 1 week after embolization on oral antibiotics for his pleural empyema with a surgical outpatient appointment regarding future cholecystectomy

Findings

Discussion

Conclusion