Branch Of Hepatic Artery Research Articles

Hepatic Arterial Anatomy Variations in Patients with Hepatocellular Carcinoma Evaluated by Computed Tomography Angiography

Abstract Aim of the Work To highlight the role of CT angiography in evaluation of hepatic artery variations in patients with hepatocellular carcinoma. Patients and Methods The study was conducted from November 2022 to August 2023, 80 patient referred from oncology to radiology department at Ain Shams university hospitals for preoperative evaluation of hepatic artery anatomical variations. Results Our study included Egyptian patients who were retrospectively analyzed came for triphasic CT of the liver, the mean age of this study population is 50.06 years. It was identified normal hepatic arterial anatomy in patients (31.3The other 27 patients (42.2%) showed some variation. Regarding Michels classification, the most frequently observed abnormalities were: right hepatic artery branch of the superior mesenteric artery (Type III, n = 10, 15.6 %); left hepatic artery branch of the left gastric artery (Type II, n = 8, 12.5%); Accessory left hepatic artery of the left gastric artery (Type V, n = 5, 7.8%). Accessory right hepatic artery of the superior mesenteric artery (Type VI, n = 2, 3.1%). Replaced right hepatic artery of superior mesenteric artery and Accessory left hepatic artery of the left gastric artery (Type VIII, n = 2, 3.1%). Conclusion Hepatic arteries variations are not uncommon findings, with different anatomic variants being reported. Thus, the importance of knowing the possible variations of this structure is emphasized, which may have implications for pre-surgical, pre-laparoscopic, or even pre-interventional and this can be achieved using MSCT to minimize and avoid the major vascular complications and decrease the morbidity of patients.

A rare variation of common hepatic artery identified during pancreaticoduodenectomy: a case report and literature review from Syria

Introduction: It is common for the liver to be supplied blood by a hepatic artery branching off the coeliac trunk. Occasionally, a replaced common hepatic artery (RCHA), emerges from the superior mesenteric artery (SMA), can supply the liver in 1.5–4.0% of cases. Computed tomography (CT) angiography is a highly accurate method for identifying arterial anomalies, which may remain undetected until the time of surgery, leading to unexpected complications. Case presentation: A 53-year-old male exhibiting symptoms of decreased appetite, weight loss, vomiting, and altered sclera, urine, and stool colour, underwent a contrast-enhanced CT scan revealing biliary tract dilatation and pancreatic abnormalities, leading to a pancreaticoduodenectomy. During the surgery, an uncommon arterial finding—CHA from SMA—was noted. Pancreatic cancer was confirmed. The patient was discharged a week post-surgery without issues, emphasizing perioperative care progress. Discussion: The authors’ study focused on the detection conditions of the same hepatic artery anomaly in eight cases reported between 2017 and 2023. In two of them the anomaly was discovered in cadaver by routine autopsy. In three cases, this variation was identified before the surgery, but in three other cases it wasn’t detected until the surgical procedure. In the authors’ case, due to multiple reasons, the anomaly remained undetectable until the surgery. Conclusion: This study underscores the importance of thorough preoperative evaluation to grasp vascular variations for better patient care. Also, a noteworthy observation in our case is that the surgeon identified an expanded hepatic vessel, prompting further investigation into this anomaly.

Novel embryological classifications of hepatic arteries based on the relationship between aberrant right hepatic arteries and the middle hepatic artery: A retrospective study of contrast-enhanced computed tomography images.

Variations in hepatic arteries are frequently encountered during pancreatoduodenecomy. Identifying anomalies, especially the problematic aberrant right hepatic artery (aRHA), is crucial to preventing vascular-related complications. In cases where the middle hepatic artery (MHA) branches from aRHAs, their injury may lead to severe liver ischemia. Nevertheless, there has been little information on whether MHA branches from aRHAs. This study aimed to investigate the relationship between aRHAs and the MHA based on the embryological development of visceral arteries. This retrospective study analyzed contrast-enhanced computed tomography images of 759 patients who underwent hepatobiliary-pancreatic surgery between January 2011 and August 2022. The origin of RHAs and MHA courses were determined using three-dimensional reconstruction. All cases of aRHAs were categorized into those with or without replacement of the left hepatic artery (LHA). Among the 759 patients, 163 (21.4%) had aRHAs. Five aRHAs patterns were identified: (Type 1) RHA from the gastroduodenal artery (2.7%), (Type 2) RHA from the superior mesenteric artery (SMA) (12.7%), (Type 3) RHA from the celiac axis (2.1%), (Type 4) common hepatic artery (CHA) from the SMA (3.5%), and (Type 5) separate branching of RHA and LHA from the CHA (0.26%). The MHA did not originate from aRHAs in Types 1-3, whereas in Type 4, it branched from either the RHA or LHA. Based on the developmental process of hepatic and visceral arteries, branching of the MHA from aRHAs is considered rare. However, preoperative recognition and intraoperative anatomical assessment of aRHAs is essential to avoid injury.

Accessory right hepatic artery and its significance for a surgeon: A case report

Right hepatic artery (RHA) is a branch of the common hepatic artery; however, there are cases documented in the literature showing anatomical variations. Accessory RHA is an incidental finding during hepatobiliary and pancreatic surgery. This artery should be identified, carefully separated, and preserved during these surgeries. We encounter the variation while doing Whipple’s procedure in a 61-year-old patient diagnosed with carcinoma of the head of the pancreas. Intra-operatively, accessory RHA was present which was arising from the superior mesenteric artery. It was identified, carefully separated, and preserved. Variations in the origin of the artery may make it vulnerable to injuries during surgical procedures if due care is not taken.

Intrahepatic aneurysm in a branch of the right hepatic artery in a patient with vasculitis due to systemic lupus erythematosus

Intrahepatic aneurysm in a branch of the right hepatic artery in a patient with vasculitis due to systemic lupus erythematosus

Liver abscess with Hepatic artery branch pseudoaneurysm: a rare complication of Liver abscess, the report of two cases.

Liver abscess with Hepatic artery branch pseudoaneurysm: a rare complication of Liver abscess, the report of two cases.

Treatment of a Patient With Closed Liver Injury Using Interventional Methods:
 a Case Study

Background. Mechanical injury occupies a leading position among the causes of mortality in the working-age population. Diagnosis and treatment of isolated and combined abdominal traumas accompanied by bleeding appear to be a specific challenge. Due to difficulties in diagnosis and treatment, they are characterized by frequent complications and an increased mortality rate.Currently, there is no uniform tactics for diagnosing and treating patients with liver damage. In Russia and globally, new approaches are being actively introduced for the treatment of patients with closed liver traumas using minimally invasive techniques.The aim of study was to present a clinical case of a patient with a closed liver injury treated using interventional methods, such as angiography and embolization.Materials and methods. According to conventional techniques, the patient had to undergo laparotomy with complex manipulations to stop intra-abdominal bleeding from a ruptured liver, which would inevitably worsen her condition in the context of a presenting severe injury.Multiple studies reported that the number of postoperative complications after laparotomy is up to 41%, and in case of combined trauma 10-35% of complications can be one of the causes of death [6, 7, 8]. In order to avoid more traumatic treatment approaches, we applied tactics using minimally invasive high-tech diagnostic and treatment options.Results. To stop intra-abdominal bleeding from a liver rupture, which was previously diagnosed during multislice computed tomography (MSCT) with intravenous contrast, using interventional options, selective embolization of the segmental branch of the right hepatic artery was performed with an adhesive composition. The post-traumatic period proceeded without complications; in 14 days after the injury, the patient was discharged in satisfactory condition.Conclusion. Minimally invasive and conservative treatment of patients with closed abdominal traumas using interventional radiology can be successfully applied in specialized trauma centers.

Delayed appearance of hepatic artery pseudoaneurysm and an arterio-biliary fistula secondary to biliary leakage and bilioma formation in a liver trauma patient and its management through transarterial embolization

BackgroundPseudoaneurysm and arterio-biliary fistulas are infrequent complications of surgery or iatrogenic trauma, accidental trauma, tumors, vascular malformations, infection, and inflammation of the biliary tract. In a liver trauma patient, they evolve immediately secondary to direct vascular injury and usually present with either drop in hemoglobin level or hemobilia due to bleeding into the peritoneal space or biliary system. In the present case, there were no clinical features of hemobilia or upper gastrointestinal bleeding. Moreover, the hepatic artery pseudoaneurysm and arterio-biliary fistula evolved after a latent period of a few weeks, secondary to the toxic effects of the bile on the vessel walls due to biloma formation or biliary leakage, which is exceptionally uncommon.Case presentationThis 19-year-old male presented with a severe liver injury complicated by forming a biloma, followed by the development of a pseudoaneurysm and an arterio-biliary fistula. The appropriate hepatic artery branch was successfully embolized using an endovascular approach.ConclusionsIn a liver trauma patient, the latency period for developing a pseudoaneurysm and an arterio-biliary fistula can be from a few days to a few months due to direct vascular injury or toxic effects of the bile on the adjacent vessel walls secondary to bile leakage. Development of hepatic artery pseudoaneurysm and an arterio-biliary fistula after a latent period of a few weeks, secondary to the toxic effects of the bile on the vessel walls due to biloma formation or biliary leakage, is exceptionally uncommon. So, these liver trauma patients require close monitoring and follow-up for early detection and treatment of pseudoaneurysm and arterio-biliary fistula, especially when there are clinical or imaging features of bile leakage or biloma formation. Endovascular treatment of hepatic artery pseudoaneurysm and arterio-biliary fistulas is a safe and effective method.

Evaluation of the Venous System of Wistar Rat Liver by Injection with Epoxy Resin

The rat is the most widely used experimental model in surgical research due to several factors, including that it is easy to handle and inexpensive. It can be used in investigations related to liver regeneration, liver metastases, or transplant immunology. This study highlights the venous components of the hepatic circulation in the Wistar rat by intravascular injection of a polymer that allows the assessment of the distribution of vessels, regardless of their caliber. Five cadavers of 11-month-old male Wistar rats from the USAMV Cluj-Napoca biobase destined for incineration, were used to highlight the liver venous system. A dye mixture, consisting of epoxy resin-catalyst-blue acrylic dye in a 2:1:1 ratio, was injected. After 24 hours, biological tissues were macerated by immersion in 10% KOH solution for five days. The intrahepatic venous system is represented by the venous branches that continue into the liver lobes. Those vessels follow a parallel trajectory with the hepatic artery branches represented by the right and left ramifications. The right portal vein presents branches to the lateral and medial parts of the right lobe of the liver and the caudate lobe. The left branch of the portal vein has ramificationsfor the lateral and medial parts of the left lobe and the quadrate lobe. The technique of injecting the venous circulation of the liver, followed by tissue maceration, allowed the removal by anatomical dissection of all liver components that permits the identification of all components of the venous system, including the finest venous branches of the hepatic circulation.

Feeding artery characteristics and enhancement patterns of hepatoblastoma patients treated with transarterial chemoembolization (TACE): Digital subtraction angiography evaluation.

Hepatoblastoma is one of the most common primary malignant liver tumors in children. The incidence of hepatoblastoma has been increasing, reaching 1.2 per million children now. The transarterial chemoembolization (TACE) procedure is one of the most practical and effective treatment options besides surgery. Digital subtraction angiography (DSA) is performed as the first step of the TACE procedure. The aim of this study was to provide information about the feeding arteries and enhancement pattern of the hepatoblastoma that was assessed by DSA before the TACE procedure. A retrospective study was conducted among hepatoblastoma cases that had undergone DSA on the TACE procedure to obtain information on the vascularity of the tumor. A total of 26 hepatoblastoma cases who had DSA examination as a part of their first TACE procedure were included, consisting of 15 boys and 11 girls, aged between 1-15 years. All cases were stage III and IV according to the Pre-Treatment Extent of Tumor (PRETEXT) staging classification. All hepatoblastoma cases had multiple feeding arteries, most of which were branches of the right hepatic artery. The largest diameter of the feeding artery was 1.82 mm, and the smallest was 0.63 mm. Most cases (84.62%) had strong contrast absorption, and spread evenly, either at the edges or in the center of the tumor. DSA is believed to be an accurate procedure to provide a detailed description of the feeding artery; enhancement patterns of hepatoblastoma were influenced by an adequate TACE.

A marginal branch of the left hepatic artery running along the umbilical vein and supplying the anterior surface of the liver left lobe: a report of 5 cases in 12 Japanese human fetuses.

In human fetuses, the left hepatic artery (LHA) issues the marginal artery that runs along the umbilical vein and, sometimes, reaches the umbilicus. The further observation demonstrated that, in 5 of 12 Japanese midterm fetuses (crown-rump length mm: 46, 50, 54, 59, 102), the marginal artery issued not only a thin umbilical branch but also a liver parenchymal branch that took a posterosuperior recurrent course in a peritoneal fold and supplied the anterior surface of the liver left lobe (segment III). However, in 22 Spanish fetuses of which gestational ages corresponded to the Japanese ones, we did not find the parenchymal branch. Therefore, between human populations, there seemed to be a considerable difference in the incidence as to whether or not the marginal artery issues the liver parenchymal branch. The parenchymal branch might be degenerated at the later stages due to friction between the liver free surface and growing diaphragm.

Laparoscopic Kasai Procedure of Treating Biliary Atresia with an Aberrant Right Hepatic Artery.

Background: An aberrant vascular anatomy might present a technical pitfall for biliary atresia (BA) surgery. The purpose of this study was to report the rare cases and discuss the significance and management strategy for BA with an aberrant right hepatic artery (ARHA) by laparoscopic Kasai procedure in children. Methods: The subjects for this study were 10 consecutive type III BA patients with an ARHA who had laparoscopic Kasai procedure at our institute between January 2012 and August 2021. The common bile duct was mobilized between the right hepatic artery and the right branch of portal vein, and then lifted to the liver hilum. The fibrous cord was transected and then the laparoscopic Kasai was carried out. Results: All patients survived the laparoscopic Kasai without any intraoperative complications. The mean operative time was 235 minutes for each laparoscopic Kasai. The mean follow-up time was 32.6 months. The total and direct bilirubin dropped to normal within 4 months of surgery in 7 patients. One patient died of repeated cholangitis and liver failure 1 year after surgery. In the additional 2 patients the bilirubin levels dropped significantly after the surgery but elevated again because of repeated cholangitis and requiring ongoing observation and intermittent treatment. Conclusions: With the perfect laparoscopic skills, the common bile duct could be safely mobilized between the right hepatic artery and right branch of portal vein for the infants with type III BA associated with an ARHA, and laparoscopic Kasai could be carried out safely and successfully.

Late-onset hemobilia due to pseudoaneurysm rupture after endoscopic ultrasound-guided hepaticogastrostomy.

We report the case of a 65-year-old man who experienced hemobilia due to rupture of a pseudoaneurysm of the left hepatic artery after endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS). The patient was diagnosed with pancreatic cancer and underwent endoscopic retrograde cholangiopancreatography for obstructive jaundice. Biliary drainage was converted to EUS-HGS due to tumor invasion in the superior duodenal angle. A partially covered metal stent was placed in the B3 intrahepatic bile duct. The procedure was completed without early complications, but 50days later, the patient developed fever, elevated hepatobiliary enzymes, and shock. Contrast-enhanced computed tomography (CT) showed that the hepatic end of the HGS stent had moved slightly toward the stomach compared to the previous CT. A 6-mm pseudoaneurysm was also observed near the A3 and A4 branches of the left hepatic artery, coinciding with the hepatic end of the EUS-HGS stent. Hemostasis was achieved with coil embolization. Biliary hemorrhage due to rupture of a pseudoaneurysm should be considered in the differential diagnosis of biliary obstruction accompanied by bleeding after EUS-HGS.

Arterioportal fistula with hepatic artery pseudoaneurysm: A rare complication of percutaneous transhepatic biliary drainage

We describe a rare complication of percutaneous transhepatic biliary drainage in a 51-year-old female with recurrent hilar cholangiocarcinoma. The patient presented with blood-mixed pericatheter leak of bile, 1 month after placement of a 10F ring biliary internal-external drainage catheter through the left-sided biliary radical. Color Doppler and triphasic computed tomography angiography revealed a pseudoaneurysm arising from segment 3 branch of the left hepatic artery and an arterioportal fistula immediately distal to the pseudoaneurysm. Endovascular coil embolization of the hepatic artery proximal to the pseudoaneurysm was done which resulted in occlusion of the pseudoaneurysm and fistula as well as clinical improvement in the symptoms.

Morphological characteristics of the left gastric, common hepatic and splenic arteries. A descriptive study in human cadaveric specimens.

to evaluate the morphology of the branches of celiac trunk (CT), left gastric (LGA), common hepatic (CHA), and splenic (SA) arteries in cadaveric specimens from a sample of a Colombian population. descriptive cross-sectional study of 26 blocks from the abdominal upper segment of human cadavers who underwent forensic autopsies at the Instituto de Medicina Legal at Bucaramanga, Colombia. The vascular beds of the celiac trunk were, subsequently, perfused with a semi-synthetic resin. the diameters of LGA, CHA, and SA were 3.6±0.8mm, 5,2±1.2mm, and 5.9±1.0mm, respectively. Statistically, LGA and SA were different (p=<0.001). SA followed a linear trajectory in 8 (31%) samples, slightly tortuous in 4 (15%), and tortuous in 14 (54%). The tortuosity index was 1.25±0.18. Of the branches of CHA, the proper hepatic artery (PHA) had 4.8±1.2mm in diameter and 18.8±9.1mm in length, whereas the gastroduodenal artery (GDdA) had 4.1±0.8mm. In 2 cases (7.7%), an accessory hepatic artery from the LGA was found to supply perfusion to the left hepatic lobe. Finally, in 2 cases (7.7%) the SA came independently from the abdominal aorta. the observed emergence incidence of the CT branches from the same level as reported in the literature is lower. The characterization, along with their variants, of LGA, CHA, and SA must be considered in surgical procedures in the upper abdominal segment, to avoid iatrogenic complications.

Radiochemical Feasibility of Mixing of 99mTc-MAA and 90Y-Microspheres with Omnipaque Contrast.

Yttrium-90 (90Y) microspheres are widely used for the treatment of liver-dominant malignant tumors. They are infused via catheter into the hepatic artery branches supplying the tumor under fluoroscopic guidance based on pre-therapy angiography and Technetium-99m macroaggregated albumin (99mTc-MAA) planning. However, at present, these microspheres are suspended in radiolucent media such as dextrose 5% (D5) solution. In order to monitor the real-time implantation of the microspheres into the tumor, the 90Y microspheres could be suspended in omnipaque contrast for allowing visualization of the correct distribution of the microspheres into the tumor. The radiochemical purity of mixing 90Y-microspheres in various concentrations of omnipaque was investigated. The radiochemical purity and feasibility of mixing 99mTc-MAA with various concentrations of a standard contrast agent were also investigated. Results showed the radiochemical feasibility of mixing 90Y-microspheres with omnipaque is radiochemically acceptable for allowing real-time visualization of radioembolization under fluoroscopy.

Porto-sinusoidal vascular disorder.

It is well established that portal hypertension can occur in the absence of cirrhosis, as reported in patients with immune disorders, infections and thrombophilia. However, similar histological abnormalities primarily affecting the hepatic sinusoidal and (peri)portal vasculature have also been observed in patients without portal hypertension. Thus, the term porto-sinusoidal vascular disorder (PSVD) has recently been introduced to describe a group of vascular diseases of the liver featuring lesions encompassing the portal venules and sinusoids, irrespective of the presence/absence of portal hypertension. Liver biopsy is fundamental for PSVD diagnosis. Specific histology findings include nodular regenerative hyperplasia, obliterative portal venopathy/portal vein stenosis and incomplete septal fibrosis/cirrhosis. Since other conditions including alcohol-related and non-alcoholic fatty liver disease, or viral hepatitis, or the presence of portal vein thrombosis may occur in patients with PSVD, their relative contribution to liver damage should be carefully assessed. In addition to histology and clinical diagnostic criteria, imaging and non-invasive tests such as liver and spleen stiffness measurements could aid in the diagnostic workup. The introduction of PSVD as a novel clinical entity will facilitate collaborative studies and investigations into the underlying molecular pathomechanisms encompassed by this term.

S1666 Hepatolithiasis Caused by Right Hepatic Artery Branches Forming an Arterial Ring Compressing the Common Hepatic Duct

Introduction: Anatomic variants of the hepatic artery are common, but are generally of no physiologic significance. We present a patient with an early branching of the right hepatic artery (RHA), wherein the right anterior and right posterior sectoral arteries encircled and compressed the CHD, resulting in proximal hepatolithiasis. Case Description/Methods: A healthy 51-year-old male presented with abdominal pain, jaundice and fever. Computed tomography of the abdomen showed bilateral intrahepatic duct stones and a focal CHD stricture near its bifurcation. At endoscopic retrograde cholangiopancreatography, the stricture was dilated and a plastic biliary stent was inserted. Since the hepatolithiasis could not be cleared endoscopically, surgical common bile duct exploration was performed (Figure). At laparotomy, we identified an early bifurcation of the RHA. The right anterior artery crossed anterior to the CHD, whereas the right posterior artery coursed posterior to the CHD. These arterial branches were densely adherent to and circumferentially constricting the CHD. We performed an arterial divestment to release the anterior and posterior RHA branches from the CHD. We transected the CHD 1cm distal to its bifurcation and transposed the anterior RHA branch posterior to the CHD. We used Spyglass cholangioscopy to guide clearance of the hepatolithiasis and to evaluate the biliary epithelium. The CHD was reconstructed in an end-to-end fashion over plastic biliary stents. The patient had an uneventful postoperative course. Post operative ERCP demonstrated no evidence of stones or biliary stricture. The patient remains asymptomatic to date. Discussion: This case illustrates a rare but clinically important phenomenon of CHD compression within an arterial ring formed by the anterior and posterior sectoral branches of an early branching RHA. Tsuchiya et al. reported the first case of CHD compression caused by an anterior-crossing RHA, and coined this entity the “right hepatic artery syndrome”. Since then, 10 additional cases of CHD compression caused by topographical variants of the hepatic artery have been described. Most patients underwent surgery for bile duct exploration and bilioenteric drainage, or to release the artery from the CHD. Both surgical approaches provide a high rate of durable symptom resolution. In recent years, there have been reports describing purely endoscopic management of this condition using ERCP or direct cholangioscopy to clear intrahepatic stones.Figure 1.: Relationship between the common hepatic duct (asterisk) and the mobilized anterior (solid arrow) and posterior (dotted arrow) right hepatic artery branches.

Assessment of hepatic arterial hemodynamics with 4D flow MRI: in vitro analysis of motion and spatial resolution related error and in vivo feasibility study in 20 volunteers.

To assess the ability of four-dimensional (4D) flow MRI to measure hepatic arterial hemodynamics by determining the effects of spatial resolution and respiratory motion suppression in vitro and its applicability in vivo with comparison to two-dimensional (2D) phase-contrast MRI. A dynamic hepatic artery phantom and 20 consecutive volunteers were scanned. The accuracies of Cartesian 4D flow sequences with k-space reordering and navigator gating at four spatial resolutions (0.5- to 1-mm isotropic) and navigator acceptance windows (± 8 to ± 2 mm) and one 2D phase-contrast sequence (0.5-mm in -plane) were assessed in vitro at 3 T. Two sequences centered on gastroduodenal and hepatic artery branches were assessedin vivo for intra - and interobserver agreement and compared to 2D phase-contrast. In vitro, higher spatial resolution led to a greater decrease in error than narrower navigator window (30.5 to -4.67% vs -6.64 to -4.67% for flow). In vivo, hepatic and gastroduodenal arteries were more often visualized with the higher resolution sequence (90 vs 71%). Despite similar interobserver agreement (κ = 0.660 and 0.704), the higher resolution sequence had lower variability for area (CV = 20.04 vs 30.67%), flow (CV = 34.92 vs 51.99%), and average velocity (CV = 26.47 vs 44.76%). 4D flow had lower differences between inflow and outflow at the hepatic artery bifurcation (11.03 ± 5.05% and 15.69 ± 6.14%) than 2D phase-contrast (28.77 ± 21.01%). High-resolution 4D flow can assess hepatic artery anatomy and hemodynamics with improved accuracy, greater vessel visibility, better interobserver reliability, and internal consistency. • Motion-suppressed Cartesian four-dimensional (4D) flow MRI with higher spatial resolution provides more accurate measurements even when accepted respiratory motion exceeds voxel size. • 4D flow MRI with higher spatial resolution provides substantial interobserver agreement for visualization of hepatic artery branches. • Lower peak and average velocities and a trend toward better internal consistency were observed with 4D flow MRI as compared to 2D phase-contrast.

A case of Mirizzi syndrome accompanied by a pseudoaneurysm that ruptured into the gallbladder: successfully treated by embolization of aneurysm and sequential surgery

BackgroundAlthough visceral aneurysms are relatively rare, it can be life-threatening in case it ruptures. We report a case of Mirizzi syndrome accompanied by a pseudoaneurysm that ruptured into the gallbladder.Case presentationThe patient was a 73-year-old woman with persistent gastrointestinal bleeding and progressive jaundice. Examination revealed a pseudoaneurysm in the gallbladder artery or hepatic artery branch, and biliary hemorrhage due to gallbladder perforation was suspected. Urgent abdominal angiography revealed a pseudoaneurysm measuring 50 × 32 mm that had ruptured directly from the right hepatic artery or the cystic artery into the gallbladder. The pseudoaneurysm was successfully coiled and the bleeding was stopped. The presence of ongoing obstruction due to Mirizzi syndrome resulted in an emergency cholecystectomy being performed on the same day. On removing the impacted gallstone from the neck of the gallbladder, we found an obstruction between the lateral wall of the common bile duct and the gallbladder, this condition was diagnosed as Mirizzi syndrome with a biliobiliary fistula. After removing the impacted gallstone, a T-tube was inserted into the common bile duct. Bile leakage was observed postoperatively, but it improved with drainage. The patient fully recovered.ConclusionsWe present our experience with a case of Mirizzi syndrome accompanied by a ruptured pseudoaneurysm successfully treated with coil embolization followed by cholecystectomy. In this case, the pseudoaneurysm may have been caused by inflammation due to cholecystitis or compression of the arterial wall by a gallstone. To the best of our knowledge, Mirizzi syndrome associated with pseudoaneurysm rupture is rare. Our study suggested that cholecystectomy preceded by transcatheter arterial embolization is an effective strategy to control bleeding in patients with hemobilia due to aneurysm.