Abstract
Spontaneous cystic artery-gallbladder fistula is an extremely rare condition described in the medical literature. We have found two articles in the literature describing fistula formation between the cystic artery and gall bladder. In this report, we present a unique case of a cystic artery-gall bladder fistula that resulted in massive gastrointestinal bleeding through cystic artery erosion and was adequately managed with coil embolization.
Highlights
Haemobilia is a rare cause of upper gastrointestinal bleeding usually secondary to an iatrogenic or traumainduced abnormal cystic artery and biliary tract connection
We present a unique case of a cystic artery-gall bladder fistula that resulted in massive gastrointestinal bleeding through cystic artery erosion and was adequately managed with coil embolization
We describe a case of spontaneous cystic artery-gall bladder fistula resulting in massive gastrointestinal bleeding
Summary
Haemobilia is a rare cause of upper gastrointestinal bleeding usually secondary to an iatrogenic or traumainduced abnormal cystic artery and biliary tract connection. The abdominal pain had started two days before the presentation; it was described to be generalized and associated with bloating She endorsed having three bowel movements with bright red blood per rectum at home. The liver function tests showed mildly elevated mixed pattern with alkaline phosphatase of 313 IU/L (normal range: 44-147 IU/L), aspartate aminotransferase of 92 Units/L (normal range: 17-59 Units/L), and alanine aminotransferase of 65 Units/L (normal range: 0-35 Units/L) Given her history of abdominal pain, a CT scan was obtained, which demonstrated porcelain gall bladder with suspicion of a fistulous tract between her gallbladder, colon, and duodenum (Figure 1). On the second day of hospitalization, she developed an episode of massive bleeding per rectum after which her hemoglobin dropped from a baseline of 9.5 to 6.9 She was emergently resuscitated with intravenous fluids and four units of packed red blood cells and was taken for emergent EGD. She is recovering at home and will continue to follow up with us for possible elective cholecystectomy for finding the porcelain gall bladder, which may represent the underlying malignancy
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