Report of a Case: Pseudoaneurysm of the Cystic Artery With Hemobilia Treated by Arterial Embolization

Abstract

We report a case of hemobilia caused by pseudoaneurysm of the cystic artery in a 71-year-old woman who presented with fever and epigastric colicky pain with jaundice. Liver function tests showed signs of obstructive jaundice. On the second day, patient had a massive hematemesis and melena with hypovolemic shock. Hemobilia was diagnosed by endoscopically visualizing bleeding from the papilla of Vater. An emergent angiography demonstrated the presence of a pseudoaneurysm in the cystic artery. Selective embolization of the cystic artery was then performed to interrupt the blood flow into the pseudoaneurysm. Immediately after embolization, patient was hemodynamically stabilized. Although the patient did not undergo cholecystectomy after embolization due to severe co-morbidities, no signs of ischemic gallbladder have been observed. Hemobilia should be included in the differential diagnosis of upper gastrointestinal bleeding with unknown etiology. Embolization could be an option for pseudoaneurysms of the cystic artery especially in high-risk patients. doi:10.4021/jmc249w