Pseudoaneurysm of the Cystic Artery in Acalculous Cholecystitis Successfully Treated by Transcatheter Arterial Embolization: a case report

Pseudoaneurysms of the cystic artery are rare complications related to cholecystitis. A 74-year-old male visited our Emergency Department (ED) for abdominal pain. He was febrile and jaundiced. However, no hematemesis or melena was noted. Physical examination showed no Murphy sign. Computer Tomography (CT) showed a pseudoaneurysm near the gallbladder fossa. The patient was managed with transcatheter arterial embolization (TAE) due to his poor condition. Scheduled cholecystectomy three weeks later showed residual chronic inf lammatory process without cholelithiasis. This is the first documented case of a pseudoaneurysm caused by acalculous cholecystitis. The case also represents a rare instance in which a cystic artery pseudoaneurysm was successfully managed by TAE in the English literature. Pseudoaneurysm of the cystic artery is a rare phenomenon, which occurs as a post-operat ive complication, a result of traumatic injuries or, more infrequently, a result of calculous cholecystitis [1]. It carries the potential to cause tremendous hemorrhagic shock, and thus should be detected earlier for better prognosis [2]. Pseudoaneurysm of the visceral organs can be well-demonstrated by color Doppler ultrasound, contrast-enhanced computed tomography (CT) and angiography. In the case reported here, the pseudoaneurysm was not caused by cholelithiasis according to operative findings. It was successfully embolized with microcoils.