Case of the month 176: pseudoaneurysm of the cystic artery

A 56-year-old man presented to the emergency department from an assisted-living facility with a 2-week history of fevers and epigastric pain, and a 24-hour history of emesis. Initially, there was coffee-ground emesis followed by vomiting of bright red blood. The patient's medical history included recurrent urinary tract infections, multiple sclerosis, as well as endoscopic retrograde cholangiopancreatography and sphincterotomy performed 7 years earlier for choledocholithiasis. There were no other operations, procedures, or recent abdominal symptoms until this presentation. A diagnosis of sepsis secondary to suspected cholecystitis was made, and the patient was started on broad-spectrum intravenous antibiotics. A computed tomography (CT) of the abdomen was performed (Figure 1) followed by an abdominal ultrasound (Figure 2). (author)