Nakajima M, Hoshino H, Hayashi E, Nagano K, Nishimura D, Katada N, Sano H, Okamoto K, Kato K
Department of Internal Medicine, Koseiren Kamo Hospital, Aichi, Japan.
J Gastroenterol. 1996 Oct;31(5):750-4. doi: 10.1007/BF02347630.
Pseudoaneurysm of the cystic artery is a cause of hemobilia, and is extremely rare, with only eight cases having been reported in the world literature. We report a case of pseudoaneurysm of the cystic artery in a 72-year-old Japanese man. The patient experienced epigastric pain and melena, and was found to have jaundice and liver dysfunction. Repeated gastroendoscopy did not reveal the cause of the alimentary tract bleeding; however, color-Doppler ultrasonography detected an aneurysm of the cystic artery in the gallbladder. Selective hepatic arteriography demonstrated that the posterior branch of the cystic artery was markedly dilated and that an aneurysm had formed in the midst of the artery. We diagnosed hemobilia due to the pseudoaneurysm of the cystic artery, and associated gastrointestinal bleeding. Cholecystectomy was performed immediately. Pathologically, the gallbladder showed acute calculous cholecystitis. This case emphasizes the importance of including hemobilia in the differential diagnosis whenever gastrointestinal bleeding is associated with signs of biliary disorder; color-Doppler imaging is a favorable modality for the diagnosis of pseudoaneurysm of the cystic artery.
胆囊动脉假性动脉瘤是胆道出血的一个原因，极为罕见，世界文献中仅报道过8例。我们报告一例72岁日本男性的胆囊动脉假性动脉瘤病例。该患者出现上腹部疼痛和黑便，检查发现有黄疸和肝功能障碍。反复胃镜检查未发现消化道出血的原因；然而，彩色多普勒超声检查发现胆囊内胆囊动脉有动脉瘤。选择性肝动脉造影显示胆囊动脉后支明显扩张，动脉中部形成了一个动脉瘤。我们诊断为胆囊动脉假性动脉瘤所致的胆道出血，并伴有胃肠道出血。立即进行了胆囊切除术。病理检查显示胆囊为急性结石性胆囊炎。该病例强调了在胃肠道出血伴有胆道疾病体征时，将胆道出血纳入鉴别诊断的重要性；彩色多普勒成像对于诊断胆囊动脉假性动脉瘤是一种很好的检查方法。
