Abstract
Most cystic artery aneurysms are pseudoaneurysms associated with cholecystitis and rarely cause biliary tract hemorrhage. Meanwhile, about 90% of cholecystoduodenal fistulas are secondary to calculous cholecystitis, may cause gallstone ileus and repeated biliary infections, and are relatively rare. The case of a patient with both a pseudoaneurysm of the cystic artery and a cholecystoduodenal fistula who developed gastrointestinal bleeding and hemorrhagic shock is reported.
An 82-year-old women with a prior history of calculous cholecystitis presented with progressive anemia and repeated episodes of transient loss of consciousness. Contrast CT and upper GI endoscopy were performed, and gastrointestinal hemorrhage due to a pseudoaneurysm of the cystic artery and a cholecystoduodenal fistula was diagnosed. Semi-urgent surgery was performed, and strong adhesions between the gallbladder and duodenal bulb were found. Surgery included resection from the gastric antrum to the duodenal bulb, resection of the gallbladder, and Roux-en-Y reconstruction. The patient's postoperative course was good, and she was transferred for rehabilitation 3 months after surgery.
