Indian Journal of Surgery

, Volume 80, Issue 1, pp 87–89 | Cite as

Rupture of Cystic Artery Pseudoaneurysm: a Rare Complication of Acute Cholecystitis

  • P. R. V. Praveen Kumar Sunkara
  • Parth Ketankumar Shah
  • Kamalesh Rakshit
  • Shuvro Roy Choudhary
  • N. P. Bohidar
  • Sanjay Kumar Dubey
Case Report


Pseudoaneurysm (PA) of the cystic artery is rare. Most of the reported cases are iatrogenic and develop secondary to liver biopsy, laparoscopic cholecystectomy, ERCP, and liver transplant. Other reported causes include trauma, malignancy, arteriovenous malformations, and inflammation in the hepatobiliary and pancreatic system. Cystic artery psuedoaneurysm is usually asymptomatic but may also present as vague abdominal pain, intra-abdominal mass, and hemobilia. In the event of rupture, it may present as a catastrophic intra-peritoneal bleeding with hemorrhagic shock. Doppler ultrasound and contrast-enhanced CT scan are useful tools for the diagnosis of this condition. However, selective visceral angiography is confirmatory and offers the opportunity for therapeutic embolization. We report a case which presented with upper right quadrant abdominal pain, vomiting, and hypotension. Abdominal ultrasonography revealed subhepatic hematoma and pericholecystic fluid collection along with acute calculus cholecystitis and sludge in the bile duct. Subsequent contrast-enhanced CT and CT angiography confirmed the presence of ruptured cystic artery psuedoaneurysm with subhepatic hematoma. The patient after resuscitation underwent selective visceral angiography and successful coil embolization of the cystic artery pseudoaneurysm. During the same admission, ERCP and biliary stenting were also performed followed by laparoscopic cholecystectomy. This case reports a rare entity which was successfully treated using a multimodality strategy.


Pseudoaneurysm Cystic artery Embolization Laparoscopic cholecystectomy 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Bulut T, Yamaner S, Bugra D et al (2002) False aneurysm of hepatic artery after laparoscopic cholecystectomy. Acta Chir Belg 102(6):459–463CrossRefPubMedGoogle Scholar
  2. 2.
    Madanur MA, Battula N, Sethi H et al Pseudoaneurysm following laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int 6:294–298Google Scholar
  3. 3.
    De Molla Neto OL, Ribeiro MAF, Saad WA (2006) Pseudoaneurysm of cystic artery after laparoscopic cholecystectomy. HPB :Off J Int Hepato Pancreato Biliary Assoc 8(4):318–319CrossRefGoogle Scholar
  4. 4.
    Petrou A, Brennan N, Soonawalla Z et al (2012) Hemobilia due to cystic artery stump pseudoaneurysm following laparoscopic cholecystectomy: case presentation and literature review. Int Surg 97(2):140–144CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Loizides S, Ali A, Newton R, Singh KK (2015) Laparoscopic management of a cystic artery pseudoaneurysm in a patient with calculus cholecystitis. Int J Surg Case Rep 14:182–185CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Siddiqui NA, Chawla T, Nadeem M. Cystic artery pseudoaneurysm secondary to acute cholecystitis as cause of haemobilia. BMJ Case Rep. 2011Google Scholar
  7. 7.
    Maeda A, Kunou T, Saeki S (2002) Pseudoaneurysm of the cystic artery with hemobilia treated by arterial embolization and elective cholecystectomy. J Hepato-Biliary-Pancreat Surg 9(6):755–758CrossRefGoogle Scholar
  8. 8.
    Akatsu T, Tanabe M, Shimizu T et al (2007) Pseudoaneurysm of the cystic artery secondary to cholecystitis as a cause of hemobilia: report of a case. Surg Today 37(5):412–417CrossRefPubMedGoogle Scholar

Copyright information

© Association of Surgeons of India 2017

Authors and Affiliations

  • P. R. V. Praveen Kumar Sunkara
    • 1
  • Parth Ketankumar Shah
    • 1
  • Kamalesh Rakshit
    • 1
  • Shuvro Roy Choudhary
    • 2
  • N. P. Bohidar
    • 3
  • Sanjay Kumar Dubey
    • 4
  1. 1.Department of General Surgery and MISRabindranath Tagore International Institute of Cardiac SciencesKolkataIndia
  2. 2.Department of Interventional RadiologyRabindranath Tagore International Institute of Cardiac SciencesKolkataIndia
  3. 3.Department of GastroenterologyRabindranath Tagore International Institute of Cardiac SciencesKolkataIndia
  4. 4.Department of Surgery and MISRabindranath Tagore International Institute of Cardiac SciencesKolkataIndia

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