A 73-year-old man was readmitted to our hospital because of jaundice and recurrent right upper-quadrant abdominal pain. He had been discharged from our hospital with a diagnosis of calculus cholecystitis and cholangitis 2 days previously, and a cholecystectomy was scheduled in 2 weeks. The abdominal computed tomography scan obtained during the first hospitalization showed a 2.5 × 2.0 cm gallstone with irregular wall thickening of the gallbladder. At physical examination, icteric sclera and right subcostal tenderness with a positive Murphy sign were noted. Tarry stool developed in the following hospital course, but upper gastrointestinal endoscopy failed to identify any active bleeding lesion. Side-view duodenoscopy revealed intermittent blood coming out of the papilla of Vater. The endoscopic retrograde cholangiopancreatography revealed a mass-like lesion (Figure A, arrowheads) at the neck of the gallbladder, mimicking Mirizzi syndrome, and an adjacent movable filling defect (Figure A, arrows). Magnetic resonance study of the hepatobiliary system was performed and suggested a 2-cm enhancing soft-tissue lesion over the neck of the gallbladder with external compression of the common hepatic duct (Figure B) and a 2.5-cm stone at the fundus. The patient underwent surgical intervention with a provisional diagnosis of gallbladder neoplasm and gallstone. However, the surgical findings were as follows: (1) a 2 × 2 cm pseudoaneurysm from the right hepatic artery, protruding into the gallbladder, (2) thickening and congested gallbladder wall with partial gangrenous change over a Hartmann pouch, and (3) a pigmented gallstone over the gallbladder fundus. The gallbladder was resected. Trauma to the pseudoaneurysm caused massive bleeding during the surgery and suture of the perforation hole was performed. Angiographic embolization of the pseudoaneurysm was performed 2 days after the surgery. Angiographic reconstruction of previous magnetic resonance imaging showed a 2-cm pseudoaneurysm at the neck of the gallbladder arising from a branch of the right hepatic artery (Figure C, arrow). The patient has been free of abdominal symptoms during the 2-year follow-up period.

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