Cystic artery pseudoaneurysm—a rare complication of acute cholecystitis: review of literature

• Published in: Surgical endoscopy Vol. 36; no. 2; pp. 871 - 880
• Main Authors: Patil, Nilesh Sadashiv, Kumar, Anubhav Harshit, Pamecha, Viniyendra, Gattu, Tharun, Falari, Sanyam, Sinha, Piyush Kumar, Mohapatra, Nihar
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2022; Springer Nature B.V
• Subjects: Abdomen; Abdominal Surgery; Anemia; Aneurysm, False - diagnostic imaging; Aneurysm, False - etiology; Aneurysm, False - surgery; Aneurysms; Atherosclerosis; Cholecystectomy; Cholecystitis - surgery; Cholecystitis, Acute - complications; Cholecystitis, Acute - surgery; Diabetes; Emergency medical care; Endoscopy; Female; Fistula; Gallbladder diseases; Gallstones; Gastroenterology; Gynecology; Hepatic Artery - surgery; Hepatology; Humans; Hypertension; Inflammation; Laboratories; Medicine; Medicine & Public Health; Middle Aged; Pancreatitis; Patients; Proctology; Pseudoaneurysm; Review Article; Surgery; Thrombosis; Trauma; Veins & arteries; Cholecystectomy; Ruptured; Pseudoaneurysm; Gall bladder
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-021-08796-1

Objective To acquaint with the presentation and management of the cystic artery aneurysm by enriching the reviewed literature with our own experience. Background Cystic artery pseudoaneurysm is an uncommon entity with varied clinical presentation. Inflammation and trauma are associated with most of the cases. Limited experience with the condition challenges the management of individual cases. Materials and methods We retrieved all the reported cases of cystic artery pseudoaneurysm, published up to December 2019, from the PubMed database and excluded those arising as postoperative complications. A total of 59 cases were analyzed, and we also included our experience of managing a case of cystic artery pseudoaneurysm. Results Abdominal pain (77.9%) was the most common presentation followed by upper GI bleed (64.4%), while 19 patients (32.2%) had presented with classic Quincke’s Triad. Most of the cases were diagnosed following the rupture of the pseudoaneurysm ( n  = 49, 83.05%). Fifteen patients presented with shock. Hyperbilirubinemia (59.3%) and anemia (55.9%) were the commonest laboratory findings. Although CT angiogram remains the investigation of choice, a conventional angiogram is the gold standard and sufficed as the definitive management in 20 cases. Cholecystectomy formed the definitive management in the rest of the cases. We successfully managed a middle-aged female patient of cystic artery aneurysm with xanthogranulomatous cholecystitis by open cholecystectomy. Conclusion Cystic artery pseudoaneurysms are amenable to successful management with careful evaluation and timely cholecystectomy or angioembolization or a combination of both.