Cystic Artery Pseudoaneurysm: Current Review of Aetiology, Presentation, and Management.

Surgery Research and Practice Pub Date : 2021-11-24 eCollection Date: 2021-01-01 DOI:10.1155/2021/4492206
Seyed Mohammad Javad Taghavi, Mahendra Jaya Kumar, Ramesh Damodaran Prabha, Harald Puhalla, Craig Sommerville
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引用次数: 7

Abstract

Background: Cystic artery pseudoaneurysms are rare. Most commonly, they occur secondary to acute cholecystitis or after a cholecystectomy. Complications include haemobilia, biliary obstruction, and haemorrhage. Given the rarity and associated morbidity, a high index of suspicion is required. This article reviews the current literature on cystic artery pseudoaneurysms to investigate its aetiology, clinical presentation, and management options.

Methods: A broad search of the Medline and PubMed databases was carried through. All peer reviewed literatures published in the English language between 1991 and 2020 with keywords "cystic" and "artery" and "pseudoaneurysm" in the title were selected for review. No further exclusion criteria; all studies yielded from the search were included in the results of this review. Additionally, we present a case of cystic artery pseudoaneurysm treated at our centre and included this in our analysis.

Results: Sixty-seven case reports were found between 1991 and 2020. Aetiologies: Aetiology of cystic artery pseudoaneurysm was found to be cholecystitis in 41 instances (61.2%), cholecystectomy in 18 instances (26.8%), idiopathic in 6 instances (8.9%) cholelithiasis in 1 instance (1.5%), and pancreatitis in 1 instance (1.5%). Complications: Fifty-two cases were complicated by haemobilia (77.6%), 36 by anaemia (53.7%), 25 by biliary obstruction (37.3%), 13 by haemodynamic shock (19.4%), 9 by haemoperitoneum (13.4%), and 6 by contained rupture (8.9%). Most commonly, patients had two or more of these complications. Management: Forty-four patients were managed with endovascular embolisation (65.7%), 21 with endoscopic intervention (31.3%), 18 with open cholecystectomy (26.9%), 13 with laparoscopic cholecystectomy (19.4%), and 6 with pseudoaneurysm ligation (9%). Delayed presentation postcholecystectomy ranged from 8 days to 3 years.

Conclusions: Cystic artery pseudoaneurysms are rare complications of a common operation. The most common clinical presentation is haemobilia, which can be difficult to diagnose clinically. A high index of suspicion and prompt investigation with targeted imaging and intervention is required. This is especially pertinent in gastrointestinal bleeding postlaparoscopic cholecystectomy as a missed diagnosis could cause significant morbidity.

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Abstract Image

囊性动脉假性动脉瘤:病因、表现和治疗的最新综述。
背景:囊性动脉假性动脉瘤是罕见的。最常见的是,它们继发于急性胆囊炎或胆囊切除术后。并发症包括胆道出血、胆道梗阻和出血。鉴于罕见和相关的发病率,需要高度的怀疑指数。本文回顾了目前关于囊性动脉假性动脉瘤的文献,以探讨其病因、临床表现和治疗方案。方法:广泛检索Medline和PubMed数据库。选取1991 - 2020年间发表的英文同行评议文献,题目中包含“囊性”、“动脉”和“假性动脉瘤”等关键词。没有进一步的排除标准;本综述的结果中包括了搜索中获得的所有研究。此外,我们提出一例囊性动脉假性动脉瘤在我们的中心治疗,并纳入我们的分析。结果:1991 ~ 2020年共发现67例病例报告。病因:胆囊动脉假性动脉瘤的病因为胆囊炎41例(61.2%),胆囊切除术18例(26.8%),特发性6例(8.9%),胆石症1例(1.5%),胰腺炎1例(1.5%)。并发症:合并胆道出血52例(77.6%),合并贫血36例(53.7%),合并胆道梗阻25例(37.3%),合并血流动力学休克13例(19.4%),合并腹膜出血9例(13.4%),合并内源性破裂6例(8.9%)。最常见的是,患者有两种或两种以上的并发症。处理:44例患者行血管内栓塞(65.7%),21例患者行内镜介入(31.3%),18例患者行切开胆囊切除术(26.9%),13例患者行腹腔镜胆囊切除术(19.4%),6例患者行假性动脉瘤结扎(9%)。胆囊切除术后延迟表现从8天到3年不等。结论:囊性动脉假性动脉瘤是一种罕见的常见手术并发症。最常见的临床表现是胆道出血,这在临床上很难诊断。高度怀疑和迅速调查,有针对性的成像和干预是必要的。这尤其与腹腔镜胆囊切除术后消化道出血有关,因为漏诊可能导致显著的发病率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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期刊介绍: Surgery Research and Practice is a peer-reviewed, Open Access journal that provides a forum for surgeons and the surgical research community. The journal publishes original research articles, review articles, and clinical studies focusing on clinical and laboratory research relevant to surgical practice and teaching, with an emphasis on findings directly affecting surgical management.
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