Gallbladder Hemorrhage due to Ruptured Cystic Artery Pseudoaneurysm: A Case Report

Takuya Nojiri, Yoshiaki Tanabe, Satoru Yanagisawa, Yohichi Tohyama, Susumu Kobayashi and Katsuhiko Yanaga*

Department of Surgery, The Jikei University, Kashiwa Hospital
Department of Surgery, The Jikei University School of Medicine*

A 61-year-old man with a history of total gastrectomy treated for gallbladder hemorrhage due to a ruptured cystic artery pseudoaneurysm was admitted for pyrexia, right hypocondralgia, and hematemesis. Ultrasongraphy and abdominal plain computed tomography (CT) on admission showed a distended thick gallbladder wall with hematoma, but no gallstones. Abdominal enhanced CT after admission showed decreased distention and wall thickening of the gallbladder without obvious tumors. Angiography showed no extravasations of contrast medium in any artery. Panendoscopy showed no source of hemorrhage. The man was diagnosed with hemobillia due to gallbladder hemorrhage. After angiography, no active bleeding was recognized and elective surgery was planned. However the man developed shock on hospital day 7 due to recurrent hemorrhage, he underwent emergency cholecystectomy. Histopathologically, the gallbladder was diagnosed as having gangrenous cholecystitis. After surgery, a review of the angiogram confirmed the diagnosis of cystic artery pseudoaneurysm. Gallbladder hemorrhage should therefore be considered in the differential diagnosis of gastrointestinal hemorrhage.

Key words
gallbladder hemorrhage, cystic artery pseudoaneurysm

Reprint requests
Takuya Nojiri Department of Surgery, The Jikei University, Kashiwa Hospital
163-1 Kashiwashita, Kashiwa, 277-8567 JAPAN

Accepted
December 19, 2007

To read the PDF file you will need Abobe Reader installed on your computer.