Pseudoaneurysm of the Cystic Artery with Hemobilia: Report of a Case

膽囊動脈僞動脈瘤合併膽道出血：一病例報告

方怡仁(Yi-Jen Fang) ； 楊基滐(Chi-Chieh Yang) ； 葉永祥(Yung-Hsiang Yeh) ； 劉裕財(Yu-Tsai Liu) ； 林家禮(Chia-Li Lin) ； 吳志昇(Chih-Sheng Wu) ； 陳建華(Chien-Hua Chen) ； 郭健龍(Chien-Long Kuo)

《臺灣消化醫學雜誌》 19卷2期 (2002/06) Pp. 161-168

https://doi.org/10.6557/GJT.200206_19(2).0007

摘要

膽道出血的原因很多，膽囊動脈偽動脈瘤出血是極為罕見引起膽道出血的疾病，迄今英文文獻中僅有十二例被報導過，本文報告一位70歲男性因上消化道出血、黃疸、發燒及右上腹疼痛住院，上消化道內視鏡檢查發現膽道出血，經彩色都卜勒超音波及血管攝影檢查後，診斷為膽囊動脈偽動脈瘤出血，患者成功地接受動脈栓塞術止血及外科膽囊切除手術，術後確定診斷為膽結石症引起的膽囊動脈偽動脈瘤，患者經過手術治療後病情穩定而出院，在本文中，我們提出膽道出血的鑑別診斷中，肝動脈血管攝影是最佳的診斷工具而利用細線圈動脈栓塞術止血是可以嘗試的治療方式，尤其是病情不穩定無法承受開刀手術的患者。

關鍵字

僞動脈瘤 ； 膽囊動脈 ； 膽道出血

並列摘要

Pseudoaneurysm of the cystic artery is a rare cause of hemobilia, with only twelve cases having been reported in the English literature. We report a case of pseudoaneurysm of cystic artery in a 70-year-old Taiwanese man. He suffered from epigastric pain, GI bleeding, jaundice and abnormal liver function. Duodenoscopy demostrated bleeding from papilla of Vater. We diagnosed hemobilia due to the pseudoaneurysm of the cystic artery after selective hepatic angiography. Furthermore, we successfully controlled bleeding by embolization of the cystic artery with microcoil. He received cholecystectomy, and pathologically, the gall bladder showed acute calculous cholecystitis with pseudoaneurysm formation. This case emphasizes the importance of including hemobilia in the differential diagnosis of upper GI bleeding. Selective hepatic angiography is the diagnostic modality of choice. Furthermore, transcatheter embolization should be attempted because it permits the delay of surgical intervention in unstable and critical patients with shock or sepsis.

並列關鍵字

Pseudoaneurysm ； cyctic artery ； hemobilia