Korean J Helicobacter Up Gastrointest Res.  2018 Jun;18(2):135-141. 10.7704/kjhugr.2018.18.2.135.

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

Affiliations
  • 1Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea. drkimtaeho@gmail.com
  • 2Department of Hospital Pathology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.

Abstract

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.

Keyword

Angiography; Cholecystoduodenal fistula; Pseudoaneurysm

MeSH Terms

Abdomen
Aged
Aneurysm, False*
Angiography
Arteries*
Cholecystectomy, Laparoscopic
Cholecystitis
Cholecystitis, Acute
Consensus
Cooperative Behavior
Diagnosis
Endoscopy
Fistula
Hemobilia
Hemorrhage
Humans
Intestinal Fistula*
Ulcer
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