PMC10134114_01
Endoscopy reveals haemobilia from the papilla Vater.
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Six days later, jaundice worsened, and endoscopic retrograde cholangiopancreatography (ERCP) revealed bloody bile (Figure 1).
Contrast-enhanced computed tomography image of the extravasation of the cystic artery in arterial phase.
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Contrast-enhanced CT revealed a haematoma in the gallbladder and a pseudoaneurysm in the lateral wall of the gallbladder (Figure 2); hence, she was referred to the department of surgery.
Insertion of endoscopic nasobiliary drainage tube. Radiolucent band indicates the haematoma.
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On the same day, the EBD tube was replaced with an ENBD tube, which indicated the degree of haemorrhage and enabled lavage of the lumen in cases of obstruction (Figure 3).
Angiography of the cystic artery: (a) extravasation from the cystic artery and (b) embolisation of the cystic artery by coiling.
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The next day, angiography revealed a pseudoaneurysm of the deep branch of the cystic artery (Figure 4(a)), and coil embolisation (VortX diamond, 2-5 mm, Boston Scientific Pushable Coil, Boston Scientific, Massachusetts, USA) was performed at the periphery of the cystic artery (Figure 4(b)). No pseudoaneurysms were observed after embolisation (Figure 4(b)).
PMC10134114_02
Laparoscopy shows a tensed gall bladder.
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The gallbladder was tense and difficult to grasp, and it was necessary to aspirate the clot and bile from the gallbladder intraoperatively (Figure 5). The removed gallbladder was full of clots, but there was no major mucosal disruption or oedema.
Haematoxylin and eosin stain of the gall bladder: (a) haematoxylin and eosin stain reveals granulation tissue and (b) although abnormalities such as lysis of the medial layer of the arterial wall were not found, the histopathologic site of the pseudoaneurysm was not detected in the specimen. No abnormalities, such as lysis of the medial layer of the arterial wall or the histopathological site of the pseudoaneurysm, were detected in the specimen.
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Some erosion and haemorrhage were observed (Figure 6(a)), however, no pseudoaneurysm was detected (Figure 6(b)).
PMC10134114_03