Iatrogenic Cystic Artery Pseudoaneurysm Post Laparoscopic Cholecystectomy- A Case Report with Literature Review

1. Abstract
Cystic Artery pseudoaneurysm post laparoscopic cholecystectomy is a rare complication associated with potential risk of morbidity and mortality. This is a case of cystic artery pseudoaneurysm post laparoscopic cholecystectomy in a 27-year-old female who presented post op day 10 post laparoscopic cholecystectomy with abdominal pain, melena and haematemesis. OGDS showed no active bleeder and initial CT only showed gallbladder hematoma which was treated in percutaneous drainage. However, recurrent symptoms prompt a CT Angiography which revealed a cystic artery pseudoaneurysm with hemoperitoneum. The pseudoaneurysm was successfully treated with trans-arterial catheter embolization of the cystic artery stump. She was well post intervention but required parenteral antibiotics resulting in a 2weeks hospitalization and eventually discharged. Literature review reports only 10 cases of iatrogenic cystic artery pseudoaneurysm post laparoscopic cholecystectomy in the last two decades. Based on our literature review, the main presentation is usually hemobilia (70%), age of patient ranging 26 to 79 years old and timing of presentation ranging from 1 weeks to 3 years post laparoscopic cholecystectomy. The pathophysiology is often due to indirect or direct thermal injury during cauterization. CT angiography is the investigation of choice. Trans arterial embolization is the treatment of choice with high success rate. However, surgery still plays a role in complex cases where embolization failed. There should be a high index of suspicion of such pathology especially in patients who present with upper gastrointestinal bleed post cholecystectomy so early diagnosis and treatment can be done.