Cystic artery pseudo aneurysm in a patient with xanthogranulomatous cholecystitis: a multi-disciplinary approach towards management


  • Surabhi Sreekumar Department of General Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
  • K. J. Raghunath Department of General Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
  • S. Vijayalakshmi Department of General Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India



Pneumobilia, CAP, Quinke's triad, Xanthogranulomatous cholecystitis, Multi-disciplinary approach


Cystic artery pseudo aneurysm is a rare clinical entity, mostly occurring as a complication of laparoscopic cholecystectomy or following calculus cholecystitis. Patient presents with acute symptoms including upper gastro intestinal bleeding symptoms, abdominal pain and jaundice, the triad of symptoms termed as Quincke's triad, when there is a ruptured cystic artery pseudoaneurysm (CAP). Unruptured cases are mostly diagnosed incidentally. Here we present a 58-year-old patient presented to the emergency department with severe abdominal pain, malena and jaundice. CECT of abdomen was done which showed CAP. The patient was immediately taken up for radiological intervention and coiling of the pseudo aneurysm, which was unsuccessful. A covered stent was placed across the pseudoaneurysm in the right hepatic artery. Patient underwent Laparoscopic cholecystectomy and had an uneventful recovery. Owing to the fact that CAPs are rare entities, a high index of suspicion is required for diagnosis of the condition and when diagnosed, the patient can be managed by radiological intervention followed by definitive surgery which can be either open or laparoscopic. 


Taghavi SMJ, Jaya KM, Damodharan PR, Puhalla H, Sommerville C. Cystic artery Pseudoaneurysm: Current Review of Aetiology, Presentation, and Management. Surg Res Pract. 2021;2021:4492206

Ahmed I, Tanveer UH, Sajjad Z, Munazza B, Azeem UD, Basit S. Cystic artery pseudo-aneurysm: a complication of xanthogranulomatous cholecytitis. Br J Radiol. 2010;83(992):e165-7.

Jaganathan S, Rangarajan M, Jyothirmayi V. Cystic artery pseudoaneurysm: an uncommon complication of a common disease. Int Surg J. 2022;9(11):1894-97.

Kelly S, Shah K, Motizada J, Soggiu F, Sheth H. Laparoscopic treatment of an unruptured cystic artery pseudo-pseudoaneurysm in the presence of calculous emphysematous cholecystitis. J Surgical Case Rep. 2022;1:1-3

Sofronis L, Asad A, Richard N, Krishna Kumar Singh, Laparoscopic management of a cystic artery pseudoaneurysm in a patient with calculous cholecystitis, International Journal of Surgery Case Reports. 2015;14:182-5.

Deniz Allis, Sina Ferahman, Suleyman Demiryas, Cesur Samanci, Fethi Emre Ustabasioglu, “Laparoscopic Management of a very Rare Case: Cystic Artery Pseudoaneurysm Secondary to Acute Cholecystitis. Case Repo Surg. 2016;1489013:1-3.

She WH, Tsang S, Poon R, Cheung TT. Gastrointestinal bleeding of obscured origin due to cystic artery pseudoaneurysm. Asian J Surg. 2010;40(4):320-3.






Case Reports