Khawjah Ahmed, Khair Mugahid M, Goubran R
Letterkenny University Hospital, Letterkenny, Co. Donegal.
Galway University Hospital, Co. Galway, Ireland.
Ann Med Surg (Lond). 2024 Apr 23;86(6):3646-3651. doi: 10.1097/MS9.0000000000002038. eCollection 2024 Jun.
Cystic artery pseudoaneurysm rupture presents a rare yet potentially fatal aetiology for upper gastrointestinal (GI) bleed. While uncommon, its incidence has been rising with increased hepatobiliary surgical interventions, predominantly attributed to iatrogenic injury and rarely secondary to acute cholecystitis. Clinical manifestations typically include epigastric pain, upper GI haemorrhage, and obstructive jaundice. Due to its rarity, it is often excluded from initial differential diagnoses.
This is an unusual case of a 54-year-old male who presented with acute cholecystitis complicated by haemobilia and Mirizzi-like obstruction, in the setting of cystic artery pseudoaneurysm rupture. Initially, urgent transcatheter angiographic embolization of the cystic artery was performed to achieve hemodynamic stability. However, a triphasic computed tomography (CT) scan revealed the first attempt was unsuccessful, necessitating a second embolization. Subsequent imaging confirmed satisfactory embolization; however, a small area of liver necrosis was observed adjacent to the gallbladder. The patient was stable at discharge from the hospital and had an uncomplicated interval cholecystectomy.
This case highlights the complexity and challenges associated with diagnosing and managing cystic artery pseudoaneurysm rupture. Diagnosis often relies on arterial phase contrast-enhanced CT scan. While no guideline currently exist, management typically involves achieving hemodynamic stability through Transcatheter angiographic embolization, followed by interval cholecystectomy.
Early recognition and intervention are crucial in managing cystic artery pseudoaneurysm rupture to prevent life-threatening haemorrhagic shock. Clinicians need to consider this rare condition in patients with upper GI bleeding and abnormal liver function tests.
胆囊动脉假性动脉瘤破裂是上消化道（GI）出血的一种罕见但可能致命的病因。虽然不常见，但其发病率随着肝胆外科手术干预的增加而上升，主要归因于医源性损伤，很少继发于急性胆囊炎。临床表现通常包括上腹部疼痛、上消化道出血和梗阻性黄疸。由于其罕见性，在最初的鉴别诊断中常常被排除。
这是一例不同寻常的病例，一名54岁男性患者，表现为急性胆囊炎并发胆道出血和Mirizzi样梗阻，同时存在胆囊动脉假性动脉瘤破裂。最初，对胆囊动脉进行了紧急经导管血管造影栓塞术以实现血流动力学稳定。然而，三相计算机断层扫描（CT）显示首次尝试未成功，需要进行第二次栓塞。随后的影像学检查证实栓塞效果满意；然而，在胆囊附近观察到一小片肝坏死区域。患者出院时情况稳定，并顺利进行了择期胆囊切除术。
该病例突出了诊断和处理胆囊动脉假性动脉瘤破裂所涉及的复杂性和挑战。诊断通常依赖于动脉期增强CT扫描。虽然目前尚无指南，但治疗通常包括通过经导管血管造影栓塞术实现血流动力学稳定，随后进行择期胆囊切除术。
早期识别和干预对于处理胆囊动脉假性动脉瘤破裂以预防危及生命的失血性休克至关重要。临床医生在患有上消化道出血和肝功能检查异常的患者中需要考虑这种罕见情况。
