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Ruptured cystic artery pseudoaneurysm after self-expandable metal stent placement for malignant biliary obstruction. 2024

Takafumi Mie, and Takashi Sasaki, and Kiyoshi Matsueda, and Takeshi Okamoto, and Tatsuki Hirai, and Takahiro Ishitsuka, and Manabu Yamada, and Hiroki Nakagawa, and Takaaki Furukawa, and Tsuyoshi Takeda, and Akiyoshi Kasuga, and Masato Ozaka, and Naoki Sasahira
Department of Hepato-Biliary-Pancreatic Medicine Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan.

We report a case of ruptured cystic artery pseudoaneurysm after self-expandable metal stent placement for malignant biliary obstruction. A 78-year-old woman on palliative care after chemotherapy for unresectable pancreatic head cancer presented with obstructive jaundice. Imaging revealed a dilated common bile duct and an enlarged gallbladder with cystic wall thickening. Endoscopic retrograde cholangiopancreatography was performed and a fully-covered self-expandable metal stent was placed in the bile duct, leading to resolution of jaundice. She presented with hematochezia 7 days later. Contrast-enhanced computed tomography revealed a cystic artery pseudoaneurysm with extravasation of contrast into a blood-filled gallbladder. Hemostasis was achieved after emergent transcatheter arterial embolization. Rupture of cystic artery pseudoaneurysm should be raised as a differential diagnosis for hemobilia after self-expandable metal stent placement, particularly in cases accompanied by inflamed gallbladders.

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