PMC6547271_01
Abdominal CT showing the cystic artery pseudoaneurysm (a) and hemobilia into the common bile duct and gallbladder stone (b).
crg-0013-0089-g01.jpg
PMC6547271_01_crg-0013-0089-g01.jpg
F1
The arterial phase of dynamic CT imaging revealed not only acute suppurative cholecystitis with thickening of the gallbladder wall and inflammation of the fat surrounding the gallbladder, but also gallstone and an area of high density within the gallbladder and common bile duct, suggesting recent intraluminal bleeding; this was diagnosed as a ruptured CAP (Fig. 1).
Endoscopic retrograde cholangiography showing dilatation of the common bile duct and a plastic stent (10 Fr, 5 cm) for drainage.
crg-0013-0089-g02.jpg
PMC6547271_01_crg-0013-0089-g02.jpg
F2
Based on the stable observations of the patient, emergent endoscopic biliary drainage was performed for her obstructive jaundice (Fig. 2).
a, b Endoscopy showing the hemorrhage from the papilla of Vater.
crg-0013-0089-g03.jpg
PMC6547271_01_crg-0013-0089-g03.jpg
F3
Besides, hemorrhage from the papilla of Vater was clearly visualized, suggesting active hemobilia (Fig. 3).
Angiography showing the cystic artery pseudoaneurysm before embolization (a) and after embolization (disappeared) (b).
crg-0013-0089-g04.jpg
PMC6547271_01_crg-0013-0089-g04.jpg
F4
For her hemostasis, embolization by using HydroCoil for the culprit cystic artery was successfully performed, resulting in the absence of aneurysm (Fig. 4).