Machida Haruhiko, Ueno Eiko, Shiozawa Shunichi, Fujimura Mikihiko, Tsuchiya Akira, Kim Dal Ho, Ogawa Kenji, Aiba Motohiko
Department of Radiology, Tokyo Women's Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan.
Radiat Med. 2008 Jul;26(6):384-7. doi: 10.1007/s11604-008-0243-x. Epub 2008 Aug 3.
Pseudoaneurysm of the cystic artery is rare; to our knowledge, fewer than 30 cases have been reported worldwide. We report the first case of an unruptured pseudoaneurysm of the cystic artery with concurrent acute calculous cholecystitis. We incidentally detected the aneurysm by contrast-enhanced computed tomography (CT) in the edematous, thickened wall of the gallbladder neck in a 71-year-old man, whereas in most of the reported cases the disease presented as hemobilia. Because of the high risk of aneurysm rupture in this location, we avoided such interventions as percutaneous cholecystostomy and laparoscopic cholecystectomy. The aneurysm was localized pathologically in the undisrupted gallbladder wall, and elective open cholecystectomy with ligation of the cystic artery was performed successfully. Our case highlights the usefulness of CT for both diagnosis and patient management. Open cholecystectomy with ligation of the cystic artery is demonstrated as a reasonable first line of treatment for this unusual condition.
胆囊动脉假性动脉瘤罕见；据我们所知，全球报道的病例少于30例。我们报告首例并发急性结石性胆囊炎的未破裂胆囊动脉假性动脉瘤病例。在一名71岁男性患者中，我们通过对比增强计算机断层扫描（CT）偶然在胆囊颈部水肿、增厚的壁中检测到动脉瘤，而在大多数报道的病例中，该病表现为胆道出血。由于该部位动脉瘤破裂风险高，我们避免了经皮胆囊造瘘术和腹腔镜胆囊切除术等干预措施。动脉瘤在病理上定位于未破裂的胆囊壁，成功实施了择期开放性胆囊切除术并结扎胆囊动脉。我们的病例突出了CT在诊断和患者管理方面的有用性。对于这种不寻常的情况，开放性胆囊切除术并结扎胆囊动脉被证明是合理的一线治疗方法。
