A case of hemobilia due to ruptured right hepatic artery aneurysm formed within a gallbladder cancer

Abstract

An 88-year-old man with abdominal discomfort and tarry stools was referred to our hospital for further examination and treatment. Contrast-enhanced computed tomography (CE-CT) showed an irregularly thickened gallbladder wall, which strongly suggested advanced gallbladder cancer. In addition, the right hepatic artery was found in the inside of the tumor, and an aneurysm was formed in the right hepatic artery. CE-CT also revealed a suspicious finding of blood clots in the gallbladder, which was associated with hemobilia. We decided to plan transcatheter arterial embolization (TAE) following antibiotics administration for coexisting acute cholangitis. After admission, a large amount of melena was observed, and re-examined CE-CT demonstrated an enlarged aneurysm. Therefore, we performed emergency TAE and the aneurysm was embolised. Cytological examination for brushing specimens obtained during subsequently performed ERCP revealed adenocarcinoma. This is a rare case of a ruptured hepatic artery aneurysm formed inside gallbladder cancer.