Hemobilia due to Pseudoaneurysm of Cystic Artery Causing Massive Upper Gastrointestinal Bleed in a Child – A Case Report

Background: Hemobilia due to nontraumatic etiology is a rare cause of upper gastrointestinal bleeding. Clinical Description: We report a 12-year-old boy who presented with severe right upper abdominal pain, yellowish discoloration of eyes, hematemesis, and black stools for 3 days. He had a similar episode 3 months ago. On examination, he was afebrile, with pallor, icterus, and circulatory shock. There was tenderness in the right hypochondrium but no organomegaly, shifting dullness, or dilated veins over the abdomen or back. Management and Outcome: After management of shock with fluids and blood transfusion, a contrast-enhanced computed tomography of the abdomen was done, showing active contrast leak into the gall bladder suggestive of hemobilia, likely due to a cystic artery pseudoaneurysm (CAP). The child underwent surgery with cholecystectomy and cystic artery ligation after confirmation with intraoperative upper GI endoscopy, with good recovery. The histopathology of the surgical specimen was suggestive of chronic cholecystitis, which may be the possible etiology of pseudoaneurysm. On follow-up, the child was doing good with no further episodes. Conclusion: CAP causing hemobilia needs a high clinical suspicion, relevant investigation, and urgent intervention for definitive management.