Cystic artery aneurysm of the gallbladder: A report of two cases

Abstract

Gallbladder aneurysm is a rare condition that occurs when inflammation of acute cholecystitis spreads to the artery of the gallbladder. According to previous reports, this condition is considered to be related to atherosclerosis. In this paper, we report two cases of gallbladder aneurysm. In the first case, we initially offered medical treatment for cholecystitis and later performed emergency surgery due to hemorrhage in the gallbladder. During surgery, intraoperative hemostasis was difficult to achieve due to the bleeding; therefore, the patient underwent damage control surgery, followed by successful treatment with endovascular procedures. In the second case, contrast-enhanced computed tomography (CECT) to assess the cholecystitis showed a gallbladder aneurysm. Although the cholecystitis was resolving with conservative treatment, considering the risk of a possible rupture of the aneurysm, we performed laparoscopic surgery without injuring the aneurysm. The experience of the first case was useful in deciding the indication of surgery in the second case. Although the Tokyo guidelines for the management of acute cholecystitis recommend CECT, elderly patients and patients with renal dysfunction may be unsuitable to undergo such assessment. Even in such cases, if CECT is deemed appropriate after the initial medical treatment, the patient should be assessed before surgery to rule out possible presence of a gallbladder aneurysm.