Case ReportAcute hemobilia from a pseudoaneurysm of the cystic artery arising from the left hepatic artery: Case report and literature review

•Hemobilia is a very rare emergency. Among non-iatrogenic causes pseudoaneurysm of cystic artery should be considered.•Knowledge of anatomical variations of cystic artery is fundamental in hepatobiliary surgical and radiologic procedures.•Because of extreme rarity of the aneurysms of cystic artery there are no guidelines about their management and treatment.

IntroductionHemobilia represents only 6% of all causes of upper gastrointestinal bleeding.Presentation of caseWe report a rare case of a bleeding pseudoaneurysm of the cystic artery, due to a re-activation of a chronic cholecystitis, which arose with a mixed symptomatology: jaundices and hematemesis.DiscussionThe rarity of our patient is increased for some vascular anatomic variations detected by Computed Tomography that influenced the management of the disease.Our patient was treated by endovascular embolization of the pseudoaneurysm and subsequent cholecystectomy.ConclusionAbout pseudoaneurysm of the cystic artery only few cases have been already reported and to date there are no guidelines for its management.We describe both diagnostic features and therapeutic strategies in comparison to the most recent literature.