Title Acute cholecystitis with massive upper gastrointestinal bleed: a case report and review of the literature Authors

Background: Pseudoaneurysm of the cystic artery is a rare complication following cholecystitis and its presentation as upper gastrointestinal hemorrhage (UGIH) is even more rare. Thirteen such cases have been reported with only 2 of them presented with UGIH alone. Case presentation: We report a case of cystic artery pseudoaneurysm in a 43-year-old woman following an acute attack of cholecystitis. She presented with a history hematemesis and malena along with postural symptoms. Upper gastrointestinal endoscopy revealed a duodenal ulcer with adherent clots in the first part of duodenum. An ultrasonography done to confirm gallstones incidentally picked up a pseudoaneurysm at the porta hepatis probably arising from hepatic artery. Selective hepatic angiography then performed showed two small pseudo aneurysms in relation to the cystic artery. Selective embolization of the cystic artery was performed successfully in view of previous history of bleed and for stabilization of patient before definitive procedure. But patient underwent emergency exploration for suspicion of gangrene of the gall bladder. Cholecystectomy with CBD exploration along repair of the duodenal rent with pyloric exclusion and gastrojejunostomy was performed. Conclusions: This case emphasizes the awareness of rare complication following cholecystitis with such unusual presentation. Cholecystectomy with ligation of pseudoaneurysm remains the treatment of choice.