Cystic artery pseudoaneurysm: an uncommon complication of a common disease


  • Sriram Jaganathan Department of Radiology, Global Hospitals and Health City, Chennai, Tamil Nadu, India
  • Medhini Rangarajan Department of Surgery, SRM Medical College, Kattangulathur, Tamil Nadu, India
  • Velaga Jyothirmayi Department of Radiology, Global Hospitals and Health City, Chennai, Tamil Nadu, India



Cystic artery pseudoaneurysm, Melena, Hemobilia


Cystic artery pseudoaneurysm, though rare, is a notable cause of upper GI bleed. Here, we report an unusual presentation of upper gastrointestinal haemorrhage due to a cystic artery pseudoaneurysm secondary to acute cholecystitis in a 54-year-old male. Initial imaging revealed cholelithiasis with evidence of acute cholecystitis. Further investigations with Doppler ultrasound and CT suggested evidence of a cystic artery pseudoaneurysm with hyperdense contents in the gall bladder suggesting blood products. Taking into consideration the risk of hemorrhage during the procedure, the patient was taken up for open cholecystectomy. This case emphasizes the need for a high level of awareness of pseudo-aneurysmal disease and inclusion of cystic artery pseudoaneurysm as one of the differential diagnosis for a patient presenting with recurrent upper quadrant pain, jaundice and melena or hemobilia.


Taghavi SMJ, Jaya Kumar M, Damodaran Prabha R, Puhalla H, Sommerville C. Cystic Artery Pseudoaneurysm: Current Review of Aetiology, Presentation, and Management. Surg Res Pract. 2021;2021:4492206.

Machado NO, Al-Zadjali A, Kakaria AK, Younus S, Rahim MA, Al-Sukaiti R. Hepatic or Cystic Artery Pseudoaneurysms Following a Laparoscopic Cholecystectomy: Literature review of aetiopathogenesis, presentation, diagnosis and management. Sultan Qaboos Univ Med J. 2017;17(2):e135-46.

Berry R, Han JY, Kardashian AA, LaRusso NF, Tabibian JH. Hemobilia: Etiology, diagnosis, and treatment☆. Liver Res. 2018;2(4):200-8.

Loizides S, Ali A, Newton R, Singh KK. Laparoscopic management of a cystic artery pseudoaneurysm in a patient with calculus cholecystitis. Int J Surg Case Rep. 2015;14:182-5.

Kumar A, Sheikh A, Partyka L, Contractor S. Cystic artery pseudoaneurysm presenting as a complication of laparoscopic cholecystectomy treated with percutaneous thrombin injection. Clin Imaging. 2014;38(4):522-5.

Nakase Y, Takagi T, Fukumoto K, Kassai K, Yamagami T, Itani K, et al. Hemobilia and cystic artery stump pseudoaneurysm associated with liver abscess after a laparoscopic cholecystectomy: report of a case. Surg Today. 2008;38(6):567-71.

Hall TC, Sprenger De Rover W, Habib S, Kumaran M. Cystic artery pseudoaneurysm secondary to acute cholecystitis: an unusual cause for haemobilia. BJR Case Rep. 2016;2(2):20150423.

Fujimoto Y, Tomimaru Y, Hatano H, Noguchi K, Nagase H, Hamabe A, et al. Ruptured Cystic Artery Pseudoaneurysm Successfully Treated with Urgent Cholecystectomy: A Case Report and Literature Review. Am J Case Rep. 2018;19:187-93.

Praveen Kumar Sunkara PRV, Shah PK, Rakshit K, Choudhary SR, Bohidar NP, Dubey SK. Rupture of Cystic Artery Pseudoaneurysm: a Rare Complication of Acute Cholecystitis. Indian J Surg. 2018;80(1):87-9.

Proença AL, Veloso Gomes F, Costa N, Bilhim T, Luz JH, Coimbra É. Transarterial Embolization of Iatrogenic Cystic Artery Pseudoaneurysm. GE Port J Gastroenterol. 2020;27(2):115-8.

Tapnio RH, Kolber MK, Shukla PA, Berkowitz E. Transcatheter Embolization of Cystic Artery Pseudoaneurysms Secondary to Acute Cholecystitis. Vasc Endovascular Surg. 2017;51(7):498-500.

Saluja SS, Ray S, Gulati MS. Acute cholecystitis with massive upper gastrointestinal bleed: A case report and review of the literature. BMC Gastroenterol. 2007;7:12.

Maeda A, Kunou T, Saeki S, Aono K, Murata T, Niinomi N, et al. Pseudoaneurysm of the cystic artery with hemobilia treated by arterial embolization and elective cholecystectomy. J Hepatobiliary Pancreat Surg. 2002;9(6):755-8.

Akatsu T, Tanabe M, Shimizu T, Handa K, Kawachi S, Aiura K, et al. Pseudoaneurysm of the cystic artery secondary to cholecystitis as a cause of hemobilia: report of a case. Surg Today. 2007;37(5):412-7.

Nkwam N, Kate H. Unruptured Pseudoaneurysm of the cystic artery associated with acute calculus cholecystitis. J Surgical Case Rep. 2010;2:4.






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