Cystic Artery Pseudoaneurysm Bleed With Gallbladder Perforation - A Challenging Clinical Problem

Cystic artery pseudoaneurysm bleed is rare which becomes potentially fatal when associated with gallbladder perforation. We report two cases of elderly men who presented with acute onset abdominal pain, shock, metabolic acidosis, low haemoglobin and deranged renal functions. The first patient was resuscitated and with a clinical diagnosis of gallbladder perforation, a percutaneous drain was inserted. However, due to its haemorrhagic output and slow fall in Hb, a computed tomography abdominal angiography was done later which diagnosed cystic artery pseudoaneurysm, which was coil embolized and he underwent elective cholecystectomy. The second patient was hemodynamically unstable and underwent an emergency laparotomy, ligation of the cystic artery pseudoaneurysm and open cholecystectomy. We discuss the diagnostic and management challenges faced in both these cases.