Perforated gallbladder after cystic artery pseudoaneurysm embolization: A case report and review of the literature

Introduction: Cystic artery pseudoaneurysm (CAP) is an uncommon complication of cholecystitis. Transarterial embolization is an effective treatment for CAP rupture, but it carries a theoretical risk of gallbladder (GB) ischemia, which is rarely reported. Case Report: A 75-year-old diabetic woman who presented with acute calculous cholecystitis complicated by CAP rupture, manifesting as massive hematemesis and melena. Urgent angiography demonstrated a large cystic artery pseudoaneurysm, which was successfully embolized using an NBCA–Lipiodol mixture. One week after embolization, the patient developed fever and right upper quadrant pain. Imaging revealed a perforated, gangrenous gallbladder with a large subhepatic abscess. As the patient was a poor surgical candidate, percutaneous transhepatic drainage was performed, resulting in complete resolution of the abscess and clinical recovery. This case highlights that the fear of gallbladder perforation should not contraindicate life-saving cystic artery embolization, as it remains amenable to minimally invasive treatment. Conclusion: Gallbladder ischemia and perforation following cystic artery embolization are rare but important complications. In surgically unfit patients, percutaneous catheter drainage can provide an effective, minimally invasive alternative to cholecystectomy.