A Ruptured Cystic Artery Pseudoaneurysm with Concurrent Cholecystoduodenal Fistula: A Case Report and Literature Review

• Main Authors: Dong Hwi Kim, Tae Ho Kim, Chang Whan Kim, Jae Hyuck Chang, Sok Won Han, Jae Kwang Kim, Seung Hwan Lee, Jeana Kim
• Format: Article
• Language: English
• Published: Yong Chan Lee 2018-06-01
• Series: The Korean Journal of Helicobacter and Upper Gastrointestinal Research
• Subjects: Angiography; Cholecystoduodenal fistula; Pseudoaneurysm
• Online Access: http://www.helicojournal.org/journal/view.html?doi=10.7704/kjhugr.2018.18.2.135

Pseudoaneurysms of the cystic artery and cholecystoduodenal fistula formation are rare complications of cholecystitis and either may result from an inflammatory process in the abdomen. A 68-year-old man admitted with acute cholecystitis subsequently developed massive upper gastrointestinal (GI) bleeding. Abdominal computed tomography showed acute calculous cholecystitis and hemobilia secondary to bleeding from the cystic artery. Angiography suggested a ruptured pseudoaneurysm of the cystic artery. Upper GI endoscopy showed a deep active ulcer with an opening that was suspected to be that of a fistula at the duodenal bulb. The patient was managed successfully with multimodality treatment that included embolization followed by elective laparoscopic cholecystectomy. Presently, there is no clear consensus regarding the clinical management of this disease. We have been able to confirm various clinical features, diagnoses, and treatments of this disease through a literature review. A multidisciplinary approach through interagency/interdepartmental collaboration is necessary for better management of this disease.