Jaundice and bleeding caused by cystic artery pseudoaneurysm after cholecystectomy: A case report

Abstract

Rationale: Cystic artery pseudoaneurysm (PSA) after laparoscopic cholecystectomy is a rare but potentially fatal complication that can lead to both jaundice and gastrointestinal bleeding.

Patient concerns: A 42-year-old woman, who was previously asymptomatic and undergoing a routine health examination, presented with jaundice and gastrointestinal bleeding 5 months after her laparoscopic cholecystectomy.

Diagnoses: Initial MRCP raised concerns for bile duct obstruction, prompting consideration of biliary trauma or tumor. However, contrast-enhanced CT and subsequent angiography revealed a 2.5 cm PSA at the previous cystic artery branch, compressing the bile duct.

Interventions: The patient underwent transarterial embolization (TAE) using stainless steel coils to occlude the PSA and control bleeding. This minimally invasive procedure successfully addressed the vascular lesion.

Outcomes: Following TAE, the patient's jaundice resolved, liver function normalized, and gastrointestinal bleeding ceased. She recovered without complications and remained asymptomatic during a 1-year follow-up.

Lessons: Early multimodal imaging is critical for identifying rare vascular complications, such as cystic artery PSA, following laparoscopic cholecystectomy, while prompt minimally invasive interventions are essential for preventing severe outcomes.

Keywords: biliary hemorrhage; cystic artery pseudoaneurysm; jaundice; laparoscopic cholecystectomy complications; transarterial embolization (TAE).

Figure 1.

Enhanced CT scan of the chest and abdomen. (A) Axial view showing a high-density lesion (red arrow) at the gallbladder fossa, which is connected to the right hepatic artery (blue arrow). (B) Axial view demonstrating significant dilation of the intrahepatic bile ducts due to compression by the lesion (purple arrow). (C) Coronal view revealing the lesion (red arrow) originating from the right hepatic artery (blue arrow), a branch of the proper hepatic artery (green arrow). (D) The lesion is located at the site of the previously resected gallbladder. CT = computed tomography.

Figure 2.

Angiography revealed the celiac trunk branching into the splenic, left gastric, and common hepatic arteries. The right hepatic artery exhibited an irregular vessel wall, with a PSA measuring approximately 2.5 cm at the location of the resected cystic artery branch. PSA = pseudoaneurysm.

Figure 3.

Multiple coils within the PSA effectively arresting blood flow. PSA = pseudoaneurysm.