PSEUDOANEURYSM OF THE CYSTIC ARTERY ASSOCIATED WITH UPPER GASTROINTESTINAL-BLEEDING

Pseudoaneurysm of the cystic artery is a cause of hemobilia, and is ex tremely rare, with only eight cases hav;ng been reported in the world literature. We report a case of pseudoaneurysm of the cystic artery in a 72-year-old Japanese man. The patient experienced epigastric pain a nd melena, and was found to have jaundice and liver dysfunction. Repea ted gastroendoscopy did not reveal the cause of the alimentary tract b leeding; however, color-Doppler ultrasonography detected an aneurysm o f the cystic artery in the gallbladder. Selective hepatic arteriograph y demonstrated that the posterior branch of the cystic artery was mark edly dilated and that an aneurysm had formed in the midst of the: arte ry. We diagnosed hemobilia due to the pseudoaneurysm of the cystic art ery, and associated gastrointestinal bleeding. Cholecystectomy was per formed immediately. Pathologically, the gallbladder showed acute calcu lous cholecystitis. This case emphasizes the importance of including h emobilia in the differential diagnosis whenever gastrointestinal bleed ing is associated with signs of biliary disorder; color-Doppler imagin g is a favorable modality for the diagnosis of pseudoaneurysm of the c ystic artery.