Ruptured cystic artery pseudoaneurysm in acute cholecystitis: A case report highlighting the role of angioembolization and early cholecystectomy- Case report

Abstract

Background: Cystic artery pseudoaneurysms are rare vascular entities, typically associated with cholecystitis or iatrogenic injury, and have a reported prevalence of 0.05-6%. While most often linked to laparoscopic cholecystectomy, they can also arise as a complication of acute cholecystitis. Rupture can lead to life-threatening haemobilia, intraperitoneal hemorrhage, or gastrointestinal bleeding, necessitating prompt diagnosis and intervention. Case Presentation: We report a case of a 69-year-old male presenting with jaundice, abdominal pain, melaena, and hematemesis. Initial investigations revealed severe anemia and a contrast-enhanced CT angiogram demonstrated a ruptured cystic artery pseudoaneurysm with haemobilia. After stabilization, angiographic embolization of the cystic artery was successfully performed. Due to the absence of collateral gallbladder perfusion, early laparoscopic cholecystectomy was undertaken. Intraoperative findings included dense adhesions, necessitating subtotal cholecystectomy. The gallbladder contained multiple mixed calculi, with the largest measuring 4×4 cm. Discussion: Haemobilia is a rare but serious complication of cystic artery pseudoaneurysm, typically presenting as Quincke’s triad. Literature review reveals most cases are diagnosed after rupture, with CT angiography and conventional angiography playing key roles in diagnosis and management. Combined angioembolization and cholecystectomy offers effective treatment with favorable outcomes when performed timely.