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

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Vascular Surgery

Background:

• Cystic artery pseudoaneurysm (CAP) rupture is a rare cause of intra-abdominal hemorrhage.
• Association with gallbladder perforation significantly increases mortality risk.
• Presents with acute abdominal pain, shock, and anemia, mimicking other acute abdominal conditions.

Purpose of the Study:

• To report two cases of elderly men with CAP rupture and gallbladder perforation.
• To discuss the diagnostic challenges and management strategies for this rare condition.

Main Methods:

• Case report of two elderly male patients.
• Initial resuscitation and management based on clinical suspicion.
• Diagnostic imaging including computed tomography (CT) abdominal angiography.
• Interventional radiology (coil embolization) and surgical interventions (ligation, cholecystectomy).

Main Results:

• Both patients presented with shock, metabolic acidosis, and anemia.
• First patient diagnosed via CT angiography, treated with coil embolization and elective cholecystectomy.
• Second patient underwent emergency laparotomy with direct ligation of the pseudoaneurysm and cholecystectomy due to hemodynamic instability.

Conclusions:

• CAP rupture with gallbladder perforation is a critical surgical emergency requiring rapid diagnosis and management.
• Multimodal approach involving imaging, interventional radiology, and surgery is often necessary.
• Early recognition and timely intervention are key to improving patient outcomes in these rare cases.