Reviewer's report
Title:Emergency cholecystectomy and hepatic arterial repair in a patient
presenting with haemobilia and massive gastrointestinal haemorrhage due to a
spontaneous cystic artery gallbladder fistula masquerading as a
pseudoaneurysm.
Version: 3Date:3 October 2012
Reviewer: Mehrdad Nikfarjam
Reviewer's report:
Title: Emergency cholecystectomy and hepatic arterial repair in a patient
presenting with haemobilia
and massive gastrointestinal haemorrhage due to a spontaneous cystic artery
gallbladder fistula masquerading as a pseudoaneurysm.
Authors describe a rare case of spontaneous cystic artery pseudoaneurysm
causing haemobilia. Management of this condition is well described as well as a
complication of attempted coiling of
Major revisions
- Nil
Minor Revisions
- Selective coil embolization of cystic artery pseudoaneurysm can be difficult.
Embolisation of the right hepatic artery, if it is giving rise to the cystic artery is not
an unreasonable option in the management of massive bleeding. The authors
chose to operate in this case and remove a clot that had migrated into the right
hepatic duct. It may be worthwhile to discuss the option of hepatic artery
embolization in selected cases, alternatively metal stenting of the hepatic artery
in this case may have solved the problem. The role of metal stenting has not
been discussed and this now much more commonly untilized.
Reviewer's report
Title:Emergency cholecystectomy and hepatic arterial repair in a patient
presenting with haemobilia and massive gastrointestinal haemorrhage due to a
spontaneous cystic artery gallbladder fistula masquerading as a
pseudoaneurysm.
Version: 3Date:3 October 2012
Reviewer: Mehrdad Nikfarjam
Reviewer's report:
Title: Emergency cholecystectomy and hepatic arterial repair in a patient
presenting with haemobilia
and massive gastrointestinal haemorrhage due to a spontaneous cystic artery
gallbladder fistula masquerading as a pseudoaneurysm.
Authors describe a rare case of spontaneous cystic artery pseudoaneurysm
causing haemobilia. Management of this condition is well described as well as a
complication of attempted coiling of
Major revisions
- Nil
Minor Revisions
- Selective coil embolization of cystic artery pseudoaneurysm can be difficult.
Embolisation of the right hepatic artery, if it is giving rise to the cystic artery is not
an unreasonable option in the management of massive bleeding. The authors
chose to operate in this case and remove a clot that had migrated into the right
hepatic duct. It may be worthwhile to discuss the option of hepatic artery
embolization in selected cases, alternatively metal stenting of the hepatic artery
in this case may have solved the problem. The role of metal stenting has not
been discussed and this now much more commonly untilized.
Please review this paper.
user
Reviewer's report
Title:Emergency cholecystectomy and hepatic arterial repair in a patient
presenting with haemobilia and massive gastrointestinal haemorrhage due to a
spontaneous cystic artery gallbladder fistula masquerading as a
pseudoaneurysm.
Version: 3Date:3 October 2012
Reviewer: Mehrdad Nikfarjam
Reviewer's report:
Title: Emergency cholecystectomy and hepatic arterial repair in a patient
presenting with haemobilia
and massive gastrointestinal haemorrhage due to a spontaneous cystic artery
gallbladder fistula masquerading as a pseudoaneurysm.
Authors describe a rare case of spontaneous cystic artery pseudoaneurysm
causing haemobilia. Management of this condition is well described as well as a
complication of attempted coiling of
Major revisions
- Nil
Minor Revisions
- Selective coil embolization of cystic artery pseudoaneurysm can be difficult.
Embolisation of the right hepatic artery, if it is giving rise to the cystic artery is not
an unreasonable option in the management of massive bleeding. The authors
chose to operate in this case and remove a clot that had migrated into the right
hepatic duct. It may be worthwhile to discuss the option of hepatic artery
embolization in selected cases, alternatively metal stenting of the hepatic artery
in this case may have solved the problem. The role of metal stenting has not
been discussed and this now much more commonly untilized.
assistant