Report and analysis of a rare case of missed and mistreated gastrointestinal bleeding secondary to gallbladder pseudoaneurysm

Report and analysis of a rare case of missed and mistreated gastrointestinal bleeding secondary to gallbladder pseudoaneurysm | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Report and analysis of a rare case of missed and mistreated gastrointestinal bleeding secondary to gallbladder pseudoaneurysm Zimo Zhu, Jun Zhu, Jintao Duan, Min Peng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5014968/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This article analyses the diagnostic and treatment process of a case of chronic gallbladder stone cholecystitis secondary to gallbladder pseudoaneurysm formation and resulting in bleeding from an ulcer in the duodenal bulb with the aim of increasing clinicians' attention to the rupture and bleeding of a ruptured pseudoaneurysm of the gallbladder artery (CAP), diagnosis and timely treatment. Informed consent was obtained from the patient before writing this article. Figures Figure 1 Figure 2 Figure 3 Figure 4 Case review female, 88 years old, was admitted to the hospital with "recurrent right upper abdominal pain, accompanied by nausea and vomiting of blood". Physical examination: right upper abdominal pressure and pain, Murphy's sign was positive, and there was no yellow discolouration of the skin and sclera. The patient had a history of gallbladder stones for more than 20 years, with recurrent episodes without surgery. MRI scanning of the epigastrium and MRCP showed multiple gallbladder stones and cholecystitis. During hospitalization, the patient had several black stools, vomited blood and dark red blood stools of about 1000 ml. Laboratory tests: bilirubin 115 umol, hemoglobin 79 g/L, and was transferred to ICU and underwent emergency gastroscopy ( Fig. 1 ): a round ulcer was seen in the greater curvature of the duodenal bulb of the duodenum of about 0.8 cm in size, with active blood oozing, which was still active after 5 titanium clips were used for closure and aluminium thioglycollate was sprayed on the duodenal bulb, and the mucosa of the descending part of the duodenum did not show any signs of blood loss. The mucosa of the descending part of the duodenum showed no abnormality. After consultation with the Department of Interventional Medicine, ultra-selective imaging of the celiac trunk artery and gastroduodenal artery and prophylactic embolisation of the upper and lower pancreaticoduodenal arteries were performed ( Figure 2 ). One day after the operation, the patient was still anaemic after blood transfusion, and laboratory tests showed that bilirubin was 144 umol and haemoglobin was 77 g/L. A further abdominal enhancement CT was performed ( Figure 3 ), which showed a clearly intensified nodular shadow in the region of the choledochal fossa, with a diameter of about 2 cm, which was not clearly demarcated from the choledochal branch of the neighbouring hepatic right artery, suggesting the formation of pseudoaneurysm. After another consultation with the Department of Interventional Medicine, considering that the bleeding was related to the rupture of the pseudoaneurysm, the patient underwent right hepatic artery superselective imaging and gallbladder artery branch superselective catheterisation as an emergency. Intraoperative imaging showed local extravasation of contrast medium from the gallbladder branch of the right hepatic artery, suggesting a pseudoaneurysm of the gallbladder artery. Further, the gallbladder artery was superselectively embolised, and the main trunk of the gallbladder artery was injected with an emulsion of medical glue and iodine oil in a ratio of 1:2 ( Figure 4 ). Repeat imaging of the hepatic artery showed the disappearance of the aforementioned contrast-concentrated area. After postoperative symptomatic treatment, the patient did not complain of abdominal pain, stools turned yellow, and was discharged smoothly. Discussion This is a case of bleeding duodenal bulb ulcer of specific cause. The patient's duodenal bulb ulcer bleeding was considered to be related to chronic gallbladder inflammation erosion encroaching on the gallbladder arteries rather than active bleeding from the ulcer itself. Biliary haemorrhage was ruled out as the patient was admitted to the hospital and endoscopy showed a bleeding duodenal bulb ulcer and no bleeding was seen in the duodenal papilla. Therefore the operator performed angiography with all attention on the gastrointestinal related arteries and performed prophylactic embolisation of the pancreaticoduodenal artery only. After the patient underwent enhanced CT examination for recurrent gastrointestinal bleeding, the operator analysed the relevant imaging data and realised that he had been deceived by the preoperative gastroscopy findings and had only focused on the gastroduodenal artery during the first intervention, ignoring the relationship between the abnormal contrast-concentrated image in the gallbladder region and the bleeding from the ulcer. Thankfully, the operator promptly performed a second DSA examination for the patient, and intraoperative imaging further confirmed the presence of a gallbladder pseudoaneurysm with haemorrhage, and the patient's postoperative gastrointestinal haemorrhage was corrected by embolisation of the gallbladder artery. The causes of gallbladder pseudoaneurysm (CAP) are inflammation, trauma, and medical factors, among which medical factors account for a large proportion of CAP [1] , and CAP caused by cholecystitis is relatively rare. In the literature, there are many underdiagnosis and misdiagnosis of CAP, and it is crucial to detect CAP in a timely manner. Most relevant case reports of GI bleeding due to CAP are due to erosion of the gallbladder or bile duct by CAP, resulting in biliary bleeding and outflow through the duodenal macropapillae [2] ， As a relatively specific symptom of CAP, most biliary bleeds are initially evaluated by endoscopy. Upper gastrointestinal endoscopy can show whether the bleeding is from the duodenal papilla in addition to ruling out other causes of bleeding [ 3 ] Further angiography can be performed to explore the cause of the biliary bleeding, as significant biliary bleeding is almost always associated with arterial injury [ 3 ] . The rarity of this case is that cholecystitis gallbladder pseudoaneurysm was the cause and duodenal ulcer haemorrhage was the result, which differs considerably from the traditional pathophysiology of peptic ulcer haemorrhage. Inspired by this case, we believe that even if endoscopy does not reveal bleeding from the duodenal papilla, or if the source of bleeding is found to be from another part of the duodenum, rupture of the CAP cannot be ruled out, and further investigations need to be carried out depending on the patient's condition. Selective angiography can directly and clearly show the location, morphology, size and source of blood supply of pseudoaneurysm, which is the gold standard for the diagnosis of pseudoaneurysm. In recent years, there have been many reports in the literature of successful treatment of pseudoaneurysms using transcatheter selective arterial embolisation (TAE) [1,4 ] . Compared with traditional surgery, TAE is performed at the same time as arteriography for definitive diagnosis, with accurate target vessel localisation, and has the advantages of less trauma, shorter operation time with higher success rate, fewer complications and faster postoperative recovery. It has been reported in the literature that after embolisation of the gallbladder artery, the gallbladder may suffer from ischemic necrosis and gallbladder gangrene [4] . In this case, the use of medical gel embolisation was chosen to block only the aneurysm-carrying artery of the local pseudoaneurysm, which did not affect the peripheral microcirculation blood supply of the gallbladder artery, and therefore complications such as necrotic perforation of the gallbladder would not occur. Through the diagnosis and treatment of this case, we have learnt clinical experience and lessons, and have gained in-depth thinking and understanding of the diagnosis and treatment of peptic ulcer bleeding, and we hope that this case can give more help and reminders to our colleagues. Declarations Author Contribution Case operator, Z.Z,J.Z.;Image post-processing and data collection，Z.Z.; Guarantors of integrity of entire study, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, J.Z.;agrees to ensure any questions related to the work are appropriately resolved, all authors;manuscript editing, all authors. References Chen, Yang-Yuan., Chen, Chih-Hsuan., Chen, Yung-Fang. A Rare Complication of Percutaneous Transhepatic Gallbladder Drainage. Gastroenterology, 2022,. Fung, A K Y., Vosough, A., Olson, S., Aly, E H., and Binnie, N R.. "An unusual cause of acute internal haemorrhage: cystic artery pseudoaneurysm secondary to acute cholecystitis." scottish medical journal 58.2 (2013). Fidelman, Nicholas., Bloom, Allan I., Kerlan, Robert K., Laberge, Jeanne M., and Wilson, Mark W.. "Hepatic arterial injuries after percutaneous biliary interventions in the era of laparoscopic surgery and liver transplantation: experience with 930 patients." Radiology 247.3 (2008). Choudhary, Abhishek., Barakat, Monique T., Higgins, Luke J., Banerjee, Subhas. "Choledochoscopic Identification of a Hepatic/Cystic Artery Pseudoaneurysm in a Patient with Hematemesis After Laparoscopic Cholecystectomy." Digestive diseases and sciences 62.6 (2017): 1439–1442. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5014968","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":351072026,"identity":"c97f75ba-a35c-4377-91a4-6eb10d2262e3","order_by":0,"name":"Zimo Zhu","email":"","orcid":"","institution":"Chengdu University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zimo","middleName":"","lastName":"Zhu","suffix":""},{"id":351072027,"identity":"b7cf5406-556c-4a06-b9b1-190d7700b946","order_by":1,"name":"Jun Zhu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYDACCSBOYGCQg/DYoKI8RGgxhqhmA/OJ0AIEiQ1Ea5Gf3WP84WGOTfr8+T0GDD/KDtfxTzvA+OBtG4O8OQ4tjHPOGBgkbkvL3XCMx4Cx59xhCYnbCcyGc9sYDHc2YNfCLJFjkJC47XDuBjYeA2bGtsMSBtIJbNK8bQwJBgewa2EDajkA1JIu34bQwv4bnxYeiRzDBqCWBIZjSLYw49MiIZFWzAD0i+GGY2kFB3vOpUvOuJ3YLDnnnIThBhxa5Gckb/74c5uNvHzz4Y0PfpRZ8/PPTj744U2ZjTwuW1AAVA1jAwM8vkbBKBgFo2AUkAUAF0ZTRvg9DIUAAAAASUVORK5CYII=","orcid":"","institution":"Second People's Hospital of Yibin","correspondingAuthor":true,"prefix":"","firstName":"Jun","middleName":"","lastName":"Zhu","suffix":""},{"id":351072028,"identity":"263a3fe8-3a36-4ff4-8e2a-7b9fb6e97816","order_by":2,"name":"Jintao Duan","email":"","orcid":"","institution":"Chengdu University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jintao","middleName":"","lastName":"Duan","suffix":""},{"id":351072032,"identity":"e3e94632-ece0-4f3e-b9b6-da66752a9b77","order_by":3,"name":"Min Peng","email":"","orcid":"","institution":"Chengdu Medical College","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"","lastName":"Peng","suffix":""}],"badges":[],"createdAt":"2024-09-02 02:50:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5014968/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5014968/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67174664,"identity":"e7675102-e17e-43b5-b8f7-9534f527cc9f","added_by":"auto","created_at":"2024-10-22 04:45:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":541270,"visible":true,"origin":"","legend":"\u003cp\u003eGastroduodenal endoscopy: a circular ulcer of about 0.8 cm in size was seen at the greater curvature of the duodenal bulb, which was still oozing active blood after being closed with five titanium clips.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5014968/v1/0191998dac6b88573a8d12e3.png"},{"id":67175358,"identity":"1ef45183-423b-4a46-bcf9-1cbe5e5fc4ed","added_by":"auto","created_at":"2024-10-22 04:53:17","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":605263,"visible":true,"origin":"","legend":"\u003cp\u003eSuperselective angiography of the gastroduodenal artery and superselective placement of a tube for embolisation of the branches of the superior and inferior pancreaticoduodenal arteries: localised extravasation of contrast medium from the gallbladder branch of the right hepatic artery is seen (undetected due to operator negligence) (blue thick arrows show pseudoaneurysm, red thick arrows show gallstones, black thick arrows show titanium clips)\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5014968/v1/da3269ecbc54e8e2b6e857dc.jpeg"},{"id":67174666,"identity":"6661a69f-b5b5-4e02-a7ba-852da6a847c1","added_by":"auto","created_at":"2024-10-22 04:45:17","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":702475,"visible":true,"origin":"","legend":"\u003cp\u003eAbdominal enhanced CT coronal view: a clearly enhanced nodular shadow is seen in the region of the gallbladder fossa, which is poorly demarcated from the gallbladder branch of the adjacent right hepatic artery, with gallbladder stones underneath, and a high-signal titanium clip shadow is seen in the left side adjacent to the greater curvature of the duodenal bulb. (Blue thick arrow shows pseudoaneurysm, red thick arrow shows gallstones, black thick arrow shows titanium clip, black thin arrow shows right hepatic artery, red thin arrow shows gallbladder artery)\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5014968/v1/9d0de6c7716d3cde99a282ae.jpeg"},{"id":67174667,"identity":"5e011f74-8916-49e8-bdeb-1c1101b071fd","added_by":"auto","created_at":"2024-10-22 04:45:17","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":636483,"visible":true,"origin":"","legend":"\u003cp\u003ea Ultra-selective imaging of the cholecystic artery: showing a localised rupture of the superficial branch of the cholecystic artery with extravasation of contrast agent in the form of a cystic concentration. Figure 4.b Repeat contrast of the common hepatic artery: shows disappearance of the above areas of contrast concentration (blue thick arrow shows pseudoaneurysm, red thick arrow shows gallstones, black thick arrow shows titanium clips)\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5014968/v1/9a16ec30419b0bcc4a7c5db2.jpeg"},{"id":77568877,"identity":"10b2ce0d-d7ef-43a2-a7f2-01261c542a70","added_by":"auto","created_at":"2025-03-03 08:02:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2721438,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5014968/v1/6956f2c6-6af0-4daf-a610-e60e7b7c7d73.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Report and analysis of a rare case of missed and mistreated gastrointestinal bleeding secondary to gallbladder pseudoaneurysm","fulltext":[{"header":"Case review","content":"\u003cp\u003efemale, 88 years old, was admitted to the hospital with \u0026quot;recurrent\u0026nbsp;right upper abdominal pain,\u0026nbsp;accompanied by nausea and vomiting of blood\u0026quot;. Physical examination:\u0026nbsp;right upper abdominal pressure and pain,\u0026nbsp;Murphy\u0026apos;s sign was positive, and\u0026nbsp;there was no yellow discolouration of the skin and sclera.\u0026nbsp;The patient had a history of gallbladder stones for more than 20 years, with recurrent episodes without surgery.\u0026nbsp;MRI scanning of the epigastrium and MRCP showed multiple gallbladder stones and cholecystitis. During hospitalization, the patient had several black stools, vomited blood and dark red blood stools of about 1000 ml. Laboratory tests: bilirubin 115 umol, hemoglobin 79 g/L, and was transferred to ICU and underwent emergency gastroscopy (\u003cstrong\u003eFig. 1\u003c/strong\u003e): a round ulcer was seen in the greater curvature of the duodenal bulb of the duodenum of about 0.8 cm in size, with active blood oozing, which was still active after 5 titanium clips were used for closure and aluminium thioglycollate was sprayed on the duodenal bulb, and the mucosa of the descending part of the duodenum did not show any signs of blood loss. The mucosa of the descending part of the duodenum showed no abnormality. After consultation with the Department of Interventional Medicine, ultra-selective imaging of the celiac trunk artery and gastroduodenal artery and prophylactic embolisation of the upper and lower pancreaticoduodenal arteries were performed\u0026nbsp;(\u003cstrong\u003eFigure 2\u003c/strong\u003e). One day after the operation, the patient was still anaemic after blood transfusion, and laboratory tests showed that bilirubin was 144 umol and haemoglobin was 77 g/L. A further abdominal enhancement CT was performed (\u003cstrong\u003eFigure 3\u003c/strong\u003e), which showed a clearly intensified nodular shadow in the region of the choledochal fossa, with a diameter of about 2 cm, which was not clearly demarcated from the choledochal branch of the neighbouring hepatic right artery, suggesting the formation of pseudoaneurysm. After another consultation with the Department of Interventional Medicine, considering that the bleeding was related to the rupture of the pseudoaneurysm, the patient underwent right hepatic artery superselective imaging and gallbladder artery branch superselective catheterisation as an emergency. Intraoperative imaging\u0026nbsp;showed local extravasation of contrast medium from the gallbladder branch of the right hepatic artery, suggesting a pseudoaneurysm of the gallbladder artery. Further, the gallbladder artery was superselectively\u0026nbsp;embolised, and the main trunk of the gallbladder artery was injected with an emulsion of medical glue and iodine oil in a ratio of 1:2 (\u003cstrong\u003eFigure 4\u003c/strong\u003e). Repeat imaging of the hepatic artery showed the disappearance of the aforementioned contrast-concentrated area. After postoperative symptomatic treatment, the patient did not complain of abdominal pain, stools turned yellow, and was discharged smoothly.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis is a case of bleeding duodenal bulb ulcer of specific cause. The patient\u0026apos;s duodenal bulb ulcer bleeding was considered to be related to chronic gallbladder inflammation erosion encroaching on the gallbladder arteries rather than active bleeding from the ulcer itself. Biliary haemorrhage was ruled out as the patient was admitted to the hospital and endoscopy showed a bleeding duodenal bulb ulcer and no bleeding was seen in the duodenal papilla. Therefore the operator performed angiography with all attention on the gastrointestinal related arteries and performed prophylactic embolisation of the pancreaticoduodenal artery only. After the patient underwent enhanced CT examination for recurrent gastrointestinal bleeding, the operator analysed the relevant imaging data and realised that he had been deceived by the preoperative gastroscopy findings and had only focused on the gastroduodenal artery during the first intervention, ignoring the relationship between the abnormal contrast-concentrated image in the gallbladder region and the bleeding from the ulcer. Thankfully, the operator promptly performed a second DSA examination for the patient, and intraoperative imaging further confirmed the presence of a gallbladder pseudoaneurysm with haemorrhage, and the patient\u0026apos;s postoperative gastrointestinal haemorrhage was corrected by embolisation of the gallbladder artery.\u003c/p\u003e\n\u003cp\u003eThe causes of gallbladder pseudoaneurysm (CAP) are inflammation, trauma, and medical factors, among which medical factors account for a large proportion of CAP\u003csup\u003e[1]\u003c/sup\u003e , and CAP caused by cholecystitis is relatively rare. In the literature, there are many underdiagnosis and misdiagnosis of CAP, and it is crucial to detect CAP in a timely manner. Most relevant case reports of GI bleeding due to CAP are due to erosion of the gallbladder or bile duct by CAP, resulting in biliary bleeding and outflow through the duodenal macropapillae\u003csup\u003e[2]\u003c/sup\u003e\u003csup\u003e，\u003c/sup\u003e As a relatively specific symptom of CAP,\u0026nbsp;most biliary bleeds are initially evaluated by endoscopy.\u0026nbsp;Upper gastrointestinal endoscopy can show whether the bleeding is from the duodenal papilla in addition to ruling out other causes of bleeding\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e3\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e Further angiography can be performed to explore the cause of the biliary bleeding,\u0026nbsp;as significant\u0026nbsp;biliary bleeding is almost always associated with arterial injury\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e3\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e .\u0026nbsp;The rarity of this case is that cholecystitis gallbladder pseudoaneurysm was the cause and duodenal ulcer haemorrhage was the result, which differs considerably from the traditional pathophysiology of peptic ulcer haemorrhage.\u0026nbsp;Inspired by this case, we believe that even if endoscopy does not reveal bleeding from the duodenal papilla, or if the source of bleeding is found to be from another part of the duodenum, rupture of the CAP cannot be ruled out, and further investigations need to be carried out depending on the patient\u0026apos;s condition.\u0026nbsp;Selective angiography can directly and clearly show the location, morphology, size and source of blood supply of pseudoaneurysm, which is the gold standard for the diagnosis of pseudoaneurysm. In recent years, there have been many reports in the literature of successful treatment of pseudoaneurysms using transcatheter selective arterial embolisation (TAE)\u003csup\u003e[1,4\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e . Compared with traditional surgery, TAE is\u0026nbsp;performed\u0026nbsp;at the\u0026nbsp;same time as arteriography for definitive diagnosis, with accurate target vessel localisation, and\u0026nbsp;has the advantages of less trauma, shorter operation time with higher success rate, fewer complications and faster postoperative recovery. It has been reported in the literature that after embolisation of the gallbladder artery, the gallbladder may suffer from ischemic necrosis and\u0026nbsp;gallbladder gangrene\u003csup\u003e[4]\u003c/sup\u003e . In\u0026nbsp;this case, the use of medical gel embolisation was chosen to block only the aneurysm-carrying artery of the local pseudoaneurysm, which did not affect the peripheral microcirculation blood supply of the gallbladder artery, and therefore complications such as necrotic perforation of the gallbladder would not occur.\u003c/p\u003e\n\u003cp\u003eThrough the diagnosis and treatment of this case, we have learnt clinical experience and lessons, and have gained in-depth thinking and understanding of the diagnosis and treatment of peptic ulcer bleeding, and we hope that this case can give more help and reminders to our colleagues.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eCase operator, Z.Z,J.Z.;Image post-processing and data collection，Z.Z.; Guarantors of integrity of entire study, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, J.Z.;agrees to ensure any questions related to the work are appropriately resolved, all authors;manuscript editing, all authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChen, Yang-Yuan., Chen, Chih-Hsuan., Chen, Yung-Fang. A Rare Complication of Percutaneous Transhepatic Gallbladder Drainage. Gastroenterology, 2022,.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFung, A K Y., Vosough, A., Olson, S., Aly, E H., and Binnie, N R.. \"An unusual cause of acute internal haemorrhage: cystic artery pseudoaneurysm secondary to acute cholecystitis.\" scottish medical journal 58.2 (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFidelman, Nicholas., Bloom, Allan I., Kerlan, Robert K., Laberge, Jeanne M., and Wilson, Mark W.. \"Hepatic arterial injuries after percutaneous biliary interventions in the era of laparoscopic surgery and liver transplantation: experience with 930 patients.\" Radiology 247.3 (2008).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoudhary, Abhishek., Barakat, Monique T., Higgins, Luke J., Banerjee, Subhas. \"Choledochoscopic Identification of a Hepatic/Cystic Artery Pseudoaneurysm in a Patient with Hematemesis After Laparoscopic Cholecystectomy.\" Digestive diseases and sciences 62.6 (2017): 1439\u0026ndash;1442.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5014968/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5014968/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis article analyses the diagnostic and treatment process of a case of chronic gallbladder stone cholecystitis secondary to gallbladder pseudoaneurysm formation and resulting in bleeding from an ulcer in the duodenal bulb with the aim of increasing clinicians' attention to the rupture and bleeding of a ruptured pseudoaneurysm of the gallbladder artery (CAP), diagnosis and timely treatment. Informed consent was obtained from the patient before writing this article.\u003c/p\u003e","manuscriptTitle":"Report and analysis of a rare case of missed and mistreated gastrointestinal bleeding secondary to gallbladder pseudoaneurysm","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-22 04:45:13","doi":"10.21203/rs.3.rs-5014968/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bc1602fd-c4eb-404c-9c92-c31b91114b25","owner":[],"postedDate":"October 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-03T07:54:10+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-22 04:45:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5014968","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5014968","identity":"rs-5014968","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}