Volume 4, Issue 4, Pages (April 2019)

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Volume 4, Issue 4, Pages 163-165 (April 2019) EUS-guided thrombin injection of cystic artery pseudoaneurysm leading to Mirizzi’s syndrome and hemobilia Malay Sharma, MD, DM, Piyush Somani, MD, DM, Rahul Talele, MD, DNB, Vikas Kohli, MD, DNB, Tagore Sunkara, MD VideoGIE Volume 4, Issue 4, Pages 163-165 (April 2019) DOI: 10.1016/j.vgie.2018.12.004 Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 Abdominal US view showing pseudoaneurysm, 3.4 cm × 2.4 cm, arising from cystic artery. VideoGIE 2019 4, 163-165DOI: (10.1016/j.vgie.2018.12.004) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 CT angiographic view showing pseudoaneurysm of cystic artery. RHA, Right hepatic artery; LHA, left hepatic artery; HAP, hepatic artery proper; CHA, common hepatic artery; GDA, gastroduodenal artery. VideoGIE 2019 4, 163-165DOI: (10.1016/j.vgie.2018.12.004) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 Linear EUS from duodenal bulb showing pseudoaneurysm. CBD, Common bile duct. VideoGIE 2019 4, 163-165DOI: (10.1016/j.vgie.2018.12.004) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 4 A stone 1 cm in diameter was seen near the neck of the gallbladder. The wall thickness of the aneurysm was 6 mm, and its internal diameter of the aneurysm was 1.5 cm. VideoGIE 2019 4, 163-165DOI: (10.1016/j.vgie.2018.12.004) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 5 A branch of the hepatic artery seen proceeding toward the neck of the pseudoaneurysm. VideoGIE 2019 4, 163-165DOI: (10.1016/j.vgie.2018.12.004) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 6 Injection of 500 units of human thrombin into the aneurysm with a 22-gauge needle. VideoGIE 2019 4, 163-165DOI: (10.1016/j.vgie.2018.12.004) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 7 ERCP image showing blood clots coming out from papilla, suggestive of hemobilia. VideoGIE 2019 4, 163-165DOI: (10.1016/j.vgie.2018.12.004) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 8 Cholangiogram showing narrowing of CHD. The length of the narrowing was about 3 cm. CHD, Common hepatic duct. VideoGIE 2019 4, 163-165DOI: (10.1016/j.vgie.2018.12.004) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 9 On dissection of the neck of the gallbladder, the thrombosed part of the aneurysm was initially delivered. Subsequently a stone present in neck area was removed. VideoGIE 2019 4, 163-165DOI: (10.1016/j.vgie.2018.12.004) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions