A case of gallbladder hemorrhage arising from a ruptured cystic artery pseudoaneurysm treated by arterial embolization with a successful follow-up two years later

Spontaneous intracholecystic bleeding secondary to a false hepatic or cystic artery aneurysm is very rare. It implies an inflammatory process that can yield a mass surrounding both the gallbladder and the duodenum and mimicking a gallbladder carcinoma. An 82-year-old man presented to the emergency department and complained of abdominal pain in the right upper quadrant, jaundice and a consequent weight loss. He experienced a CT examination that revealed a pseudoaneurysm located in the gallbladder and an extensive hypodense area near the gallbladder extending from the duodenum to the hepatic hilum with intrahepatic bile duct dilatation. A selective transcatheter arterial embolization was performed successfully. One month later the hypodense area near the duodenum decreased in size on CT follow-up while liver enzymes were normal. Nine-month and two-year follow-up showed that patient was asymptomatic and CT scans were considered normal, proven that a minimal invasive therapeutic approach in an elderly patient by means of embolization followed by clinical, biological and radiological follow-up seems to be an alternative possibility in complications hemorrhagic cholecystitis due to ruptured pseudo aneurysm.