EP-341 Haemorrhagic Cholecystitis with cystic artery pseudo-aneurysm

Abstract

Abstract Introduction Haemorrhagic cholecystitis and cystic artery pseudo-aneurysm (CAP) are two very uncommon causes of right upper abdominal pain. However, the development of haemorrhagic cholecystitis induced by ruptured cystic artery pseudo-aneurysm and haemobilia are extremely rarely documented with few occurrences documented in the literature. Case presentation A 80year-old frail patient was admitted with RUQ pain, deranged LFTs and melaena. She had known gall stones, hypertension, chronic kidney disease and fibromyalgia. She demonstrated localized tenderness in the right abdomen and bloods showed a significant drop in haemoglobin which required blood transfusion. Abdominal ultrasound showed cholecystitis and MRCP showed CBD dilatation with no choledocholithiasis. She was found to have haemorrhagic cholecystitis and CAP along with a cholecysto-colonic fistula on triple phase liver CT. The patient underwent urgent embolization of the CAP and remained clinically stable. She was discharged home with a plan of further review before consideration for cholecystectomy. Clinical discussion Haemorrhagic cholecystitis and CAP are rare. Clinical suspicion is warranted to diagnose the case – the combination of features of cholecystitis with acute anaemia should raise the suspicion. Diagnosis is made primarily by pathognomonic findings on appropriate phase of CT and US imaging. Prompt diagnosis and management is essential in preventing mortality and/or significant morbidity. Conclusion A rare consequence of intra-biliary bleeding due to ruptured CAP leading to haemorrhagic cholecystitis is a potential differential diagnosis in patients presenting with right upper abdominal pain and haemoglobin drop. Close liaison with radiologist is warranted to organise appropriate investigation for diagnosis and successfully manage the condition.