Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia.
Faculty of Medicine, University of Queensland, Brisbane, Australia.
Clin J Gastroenterol. 2023 Aug;16(4):605-609. doi: 10.1007/s12328-023-01806-w. Epub 2023 May 2.
Hemobilia is an uncommon diagnosis and is often not suspected in the absence of recent hepatobiliary intervention or trauma. Hemobilia in the setting of cystic artery pseudoaneurysm secondary to type I Mirizzi syndrome is a rare occurrence. We report the case of a 61-year-old male who presented with epigastric pain and vomiting. Blood tests demonstrated hyperbilirubinemia with elevated inflammatory markers. Magnetic resonance cholangiopancreatography revealed type I Mirizzi syndrome in the presence of a 21 mm cystic duct stone. During endoscopic retrograde cholangiopancreatography, hemobilia was identified. Subsequent triple phase computed tomography imaging identified a 12 mm cystic artery pseudoaneurysm. Angiography with successful coiling of the cystic artery was accomplished. Cholecystectomy was performed, confirming type I Mirizzi syndrome. This case demonstrates the importance of considering ruptured pseudoaneurysm in patients presenting with evidence of upper gastrointestinal bleeding in the setting of biliary stone disease. Transarterial embolization, followed by surgical management, is effective in both the diagnosis and management of ruptured cystic artery pseudoaneurysm with associated hemobilia.
肝内出血是一种罕见的诊断，在没有近期肝胆介入或创伤的情况下，通常不会怀疑。继发于Ⅰ型Mirizzi 综合征的胆囊动脉假性动脉瘤导致的肝内出血则更为罕见。我们报告了一例 61 岁男性患者，其表现为上腹痛和呕吐。血液检查显示高胆红素血症和炎症标志物升高。磁共振胰胆管成像显示存在Ⅰ型 Mirizzi 综合征，同时伴有 21mm 的胆囊管结石。在经内镜逆行胰胆管造影术期间，发现了肝内出血。随后的三期计算机断层扫描成像发现了 12mm 的胆囊动脉假性动脉瘤。成功进行了胆囊动脉的血管造影栓塞术。行胆囊切除术，证实为Ⅰ型 Mirizzi 综合征。该病例表明，在有胆道结石病的患者中，出现上消化道出血的证据时，应考虑破裂的假性动脉瘤。经动脉栓塞术，随后行手术治疗，对破裂的胆囊动脉假性动脉瘤伴相关肝内出血的诊断和治疗均有效。
