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Korean J Helicobacter  Up Gastrointest Res > Volume 18(2); 2018 > Article
The Korean Journal of Helicobacter  and Upper Gastrointestinal Research 2018;18(2):135-141.
DOI: https://doi.org/10.7704/kjhugr.2018.18.2.135    Published online June 10, 2018.
A Ruptured Cystic Artery Pseudoaneurysm with Concurrent Cholecystoduodenal Fistula: A Case Report and Literature Review
Dong Hwi Kim, Tae Ho Kim  , Chang Whan Kim, Jae Hyuck Chang, Sok Won Han, Jae Kwang Kim, Seung Hwan Lee, Jeana Kim
1Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea. drkimtaeho@gmail.com
2Department of Hospital Pathology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.
Correspondence:  Tae Ho Kim, Tel: +82-32-340-7017, Fax: +82-32-340-7227, 
Email: drkimtaeho@gmail.com
Received: 6 February 2018   • Revised: 27 March 2018   • Accepted: 27 March 2018
Abstract
Pseudoaneurysms of the cystic artery and cholecystoduodenal fistula formation are rare complications of cholecystitis and either may result from an inflammatory process in the abdomen. A 68-year-old man admitted with acute cholecystitis subsequently developed massive upper gastrointestinal (GI) bleeding. Abdominal computed tomography showed acute calculous cholecystitis and hemobilia secondary to bleeding from the cystic artery. Angiography suggested a ruptured pseudoaneurysm of the cystic artery. Upper GI endoscopy showed a deep active ulcer with an opening that was suspected to be that of a fistula at the duodenal bulb. The patient was managed successfully with multimodality treatment that included embolization followed by elective laparoscopic cholecystectomy. Presently, there is no clear consensus regarding the clinical management of this disease. We have been able to confirm various clinical features, diagnoses, and treatments of this disease through a literature review. A multidisciplinary approach through interagency/interdepartmental collaboration is necessary for better management of this disease.
Key Words: Angiography; Cholecystoduodenal fistula; Pseudoaneurysm
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