1
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Heidari A, Ghane Y, Heidari N, Kasraianfard A, Kargar M, Moradi AM. Successful management of a ruptured cystic artery pseudoaneurysm with embolization and cholecystectomy: A case report. Clin Case Rep 2024; 12:e9427. [PMID: 39286756 PMCID: PMC11402787 DOI: 10.1002/ccr3.9427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/05/2024] [Accepted: 08/29/2024] [Indexed: 09/19/2024] Open
Abstract
Key Clinical Message Cystic artery pseudoaneurysm is a rare phenomenon associated with cholecystitis. We describe the successful management of angioembolisation and cholecystectomy. Abstract Cystic artery pseudoaneurysm (CAP) is a rare but clinically significant condition with various etiological factors. Cholecystitis is a prominent cause, often leading to inflammation-induced arterial wall erosion and pseudoaneurysm formation. CAP can present with a range of symptoms, including hemobilia, upper GI bleeding, and jaundice. Despite its rarity, CAP warrants attention in emergency care due to its potential for life-threatening arterial bleeding. Timely diagnosis is crucial, with imaging techniques playing a key role. Depending on the clinical context, management options include endovascular embolization and surgical intervention. Due to the limited cases, standard protocols remain elusive. A 64-year-old woman presented with abdominal pain, anorexia, and weight loss, prompting an evaluation for possible gallbladder cancer. She experienced sudden abdominal pain and upper gastrointestinal bleeding (hematemesis). Laboratory findings revealed leukocytosis, anemia, and abnormal liver function tests. Imaging showed gallbladder wall thickening, luminal contraction, and a pseudoaneurysm in the cystic artery. The patient underwent angioembolization followed by cholecystectomy, confirming acute cholecystitis and CAP with thrombosis. This case underscores the importance of early recognition and appropriate management in CAP, particularly when accompanied by acute cholecystitis.
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Affiliation(s)
- Amirhossein Heidari
- Faculty of Medicine, Tehran Medical Sciences Islamic Azad University Tehran Iran
| | - Yekta Ghane
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Nazila Heidari
- School of Medicine Iran University of Medical Sciences Tehran Iran
| | - Amir Kasraianfard
- Liver Transplant Research Center Tehran University of Medical Sciences Tehran Iran
| | - Mahsa Kargar
- Department of Pathology, Cancer Institute Tehran University of Medical Sciences Tehran Iran
| | - Ali Mohammad Moradi
- Liver Transplant Research Center Tehran University of Medical Sciences Tehran Iran
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2
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Luc TQ, Thao BTP, Nghia NV, My TTT, Quang PV, Duc NM. Rare complications of chronic cholangitis: Pseudoaneurysm of the hepatic artery causing serious gastrointestinal bleeding. Radiol Case Rep 2024; 19:3688-3692. [PMID: 38983296 PMCID: PMC11228644 DOI: 10.1016/j.radcr.2024.05.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 07/11/2024] Open
Abstract
Gastrointestinal bleeding due to hemobilia is a rare condition but can be very serious, even life-threatening. The main causes of biliary bleeding are invasive procedures in treatment, trauma, or malignant diseases. Chronic obstruction of the biliary tract can cause inflammation, erosion, and leakage of adjacent vascular structures and lead to pseudoaneurysm or hemorrhage, but this is very rare. In this article, we present a clinical case of upper gastrointestinal bleeding due to a pseudoaneurysm of the hepatic artery believed to have formed due to chronic cholangitis. An 81-year-old female patient with a medical history of chronic cholangitis was admitted to the hospital with recurrent inflammation accompanied by progressive upper gastrointestinal bleeding, potentially life-threatening. Ultrasound images and blood tests confirmed that the patient had anemia and cholangitis caused by stones. Gastrointestinal endoscopy showed bleeding suspected to be from the biliary tract. Hepatobiliary computed tomography confirmed that the common hepatic artery pseudoaneurysm located at the upper end of the common bile duct had active bleeding.
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Affiliation(s)
- Tran Quang Luc
- Department of Radiology, Phu Tho Provincial General Hospital, Phu Tho, Vietnam
| | - Bui-Thi Phuong Thao
- Department of Radiology, Vinmec Times City International General Hospital, Hanoi, Vietnam
| | - Nguyen-Van Nghia
- Department of Radiology, The Saint Paul General Hospital, Hanoi, Vietnam
| | - Thieu-Thi Tra My
- Department of Radiology, Vinmec Times City International General Hospital, Hanoi, Vietnam
| | - Pham Vinh Quang
- Department of Hepatobiliary and Pancreatic Surgery, Binh Dan Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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3
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Stapleton P, Ha N, Saxon S, Thomson JE. Haemobilia as a primary presentation of cholangiocarcinoma. BMJ Case Rep 2024; 17:e260524. [PMID: 39209753 DOI: 10.1136/bcr-2024-260524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
We present a case of haemobilia as a primary presentation for underlying cholangiocarcinoma. A man in his 50s initially presented to emergency with Quincke's triad, RUQ pain, jaundice and UGI bleeding. The initial diagnosis of haemobilia was made on endoscopic retrograde cholangiopancreatography (ERCP) on primary presentation, but the presence of blood and the recurrent clot obstruction of the biliary tract made the underlying diagnosis extremely difficult, resulting in the patient having 4 ERCP, 1 spyglass and multiple CTs and magnetic resonance cholangiopancreatography. Eventually, the patient underwent a Whipple's procedure without tissue diagnosis, confirming cholangiocarcinoma on histopathology. This case emphasises the difficulty of diagnosis of underlying malignancy in the setting of haemobilia, the benefit of multidisciplinary meeting discussions to support significant interventions and the need to be cautious and curious when managing atypical presentations.
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Affiliation(s)
- Peter Stapleton
- The University of Sydney Discipline of Surgery, Sydney, New South Wales, Australia
- Urology, Grampians Health, Ballarat, Victoria, Australia
| | | | - Sarah Saxon
- Department of Pathology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - John-Edwin Thomson
- Hepato-pancreato-biliary Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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4
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Shen S, Daneshmand A, Qumseya B. Hemobilia due to hepatic artery pseudoaneurysm fistulizing with the common bile duct following liver transplantation. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2024; 9:376-378. [PMID: 39233840 PMCID: PMC11368668 DOI: 10.1016/j.vgie.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Affiliation(s)
- Steve Shen
- Department of Internal Medicine, University of Florida, Gainesville, Florida
| | - Arvin Daneshmand
- Department of Internal Medicine, University of Florida, Gainesville, Florida
| | - Bashar Qumseya
- Department of Internal Medicine, University of Florida, Gainesville, Florida
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5
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Rais A, Benabderrazik B, El Bouardi N, Akammar A, Haloua M, Alami B, Alaoui MYL, Boubou M, Maaroufi M. Cholecystitis-related cystic artery pseudoaneurysm: Case report. Radiol Case Rep 2024; 19:2156-2159. [PMID: 38515769 PMCID: PMC10950602 DOI: 10.1016/j.radcr.2024.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
The pseudoaneurysms of the cystic artery (CAP) are very uncommon. They usually develop as a result of an acute cholecystitis or after a cholecystectomy. Among the complications, we can find hemorrhaging, biliary blockage, and haemobilia. Limited understanding of the illness makes managing specific cases difficult. We describe a case of a cystic artery pseudoaneurysm complicating an acute cholecystitis that was successfully treated by transcatheter arterial embolization.
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Affiliation(s)
- Asmae Rais
- Department of radiology of specialities, CHU Hassan II, university Sidi Mohammed Benabdellah, Fes, Morocco
| | - Btissam Benabderrazik
- Department of radiology of specialities, CHU Hassan II, university Sidi Mohammed Benabdellah, Fes, Morocco
| | - Nizar El Bouardi
- Department of radiology of specialities, CHU Hassan II, university Sidi Mohammed Benabdellah, Fes, Morocco
| | - Amal Akammar
- Department of radiology mother and child, CHU Hassan II, university Sidi Mohammed Benabdellah, Fes, Morocco
| | - Meriem Haloua
- Department of radiology mother and child, CHU Hassan II, university Sidi Mohammed Benabdellah, Fes, Morocco
| | - Babdreddine Alami
- Department of radiology of specialities, CHU Hassan II, university Sidi Mohammed Benabdellah, Fes, Morocco
| | | | - Meryem Boubou
- Department of radiology mother and child, CHU Hassan II, university Sidi Mohammed Benabdellah, Fes, Morocco
| | - Mustapha Maaroufi
- Department of radiology of specialities, CHU Hassan II, university Sidi Mohammed Benabdellah, Fes, Morocco
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6
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Smith SA, Simpson F, Bell-Allen N, Brown N, Mudaliar S, Aftab K, Tam D, Chandrasegaram MD. Percutaneous thrombolysis via cholecystostomy catheter to dissolve biliary clots causing obstructive jaundice. J Surg Case Rep 2024; 2024:rjae055. [PMID: 38404451 PMCID: PMC10884733 DOI: 10.1093/jscr/rjae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/19/2024] [Indexed: 02/27/2024] Open
Abstract
Haemobilia, or bleeding within the biliary tree, is rare. It can cause biliary obstruction secondary to blood clots. A comorbid 87-year-old was admitted to hospital with acute cholecystitis, choledocholithiasis, and an Escherichia coli bacteremia. He had a partial pancreatectomy and gastrojejunostomy 35 years prior for severe pancreatitis. He was treated with antibiotics and a percutaneous cholecystostomy. He developed atrial fibrillation and was subsequently commenced on warfarin. He re-presented 5 days after discharge with abdominal pain and fevers. Liver function tests revealed cholestasis and a supratherapeutic international normalised ratio. Imaging showed cholecystitis, biliary obstruction, and extensive biliary blood clots. He improved with antibiotics, vitamin K, and alteplase flushes through the percutaneous cholecystostomy. Repeat cholangiogram demonstrated dissolution of the biliary clots. Due to altered anatomy and comorbidities, alteplase flushes were utilized to relieve this patient's biliary obstruction. Thrombolytics may assist in treating biliary clots when first-line options are not possible or favourable.
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Affiliation(s)
- Sonya A Smith
- Department of General Surgery, The Prince Charles Hospital, 627 Rode Rd, Chermside QLD0, Queensland 4032, Australia
| | - Fraser Simpson
- Department of General Surgery, The Prince Charles Hospital, 627 Rode Rd, Chermside QLD0, Queensland 4032, Australia
| | - Nicholas Bell-Allen
- Department of General Surgery, The Prince Charles Hospital, 627 Rode Rd, Chermside QLD0, Queensland 4032, Australia
| | - Nicholas Brown
- Department of Radiology, The Prince Charles Hospital, 627 Rode Rd, Chermside, Queensland 4032, Australia
| | - Sanjivan Mudaliar
- Department of Gastroentrology, The Prince Charles Hospital, 627 Rode Rd, Chermside, Queensland 4032, Australia
| | - Khurram Aftab
- Department of Radiology, The Prince Charles Hospital, 627 Rode Rd, Chermside, Queensland 4032, Australia
| | - Diana Tam
- Department of General Surgery, The Prince Charles Hospital, 627 Rode Rd, Chermside QLD0, Queensland 4032, Australia
| | - Manju D Chandrasegaram
- Department of General Surgery, The Prince Charles Hospital, 627 Rode Rd, Chermside QLD0, Queensland 4032, Australia
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7
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Atiku ES, Kwentoh I, Gumbs S, Donaldson B. Right Hepatic Artery Pseudoaneurysm Presenting As Upper Gastrointestinal Bleed: A Deadly Hit and Run Following Blunt Trauma. Cureus 2023; 15:e51232. [PMID: 38161539 PMCID: PMC10756165 DOI: 10.7759/cureus.51232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/03/2024] Open
Abstract
Hepatic artery pseudoaneurysm (HAA) is a rare complication of blunt trauma, occurring in only 1% of patients. It is life-threatening with abysmal and atrocious outcomes if not recognized early and managed promptly. Other etiologies include transjugular-intrahepatic portosystemic shunt (TIPS), pancreatitis, cholecystectomy, and liver transplantation. We report a near-miss case in a 38-year-old woman following a motor vehicle accident. She sustained Grade III/IV liver laceration (>50% subcapsular hematoma), presenting with upper gastrointestinal bleeding (UGIB). Our patient was managed emergently intra-operatively, with hemostasis promptly achieved; however, she continued to bleed postoperatively, becoming hemodynamically unstable and unresponsive to both massive blood transfusions and high-dose proton pump inhibitors. Further imaging demonstrated HAA for which coil embolization was carried out by interventional radiology (IR).
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Affiliation(s)
- Eric S Atiku
- General Surgery, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, USA
| | - Ifeoma Kwentoh
- Internal Medicine, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, USA
| | - Shamon Gumbs
- General Surgery, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, USA
| | - Brian Donaldson
- General Surgery, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, USA
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8
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Schütz ŠO, Rousek M, Pudil J, Záruba P, Malík J, Pohnán R. Delayed Post-Traumatic Hemobilia in a Patient With Blunt Abdominal Trauma: A Case Report and Review of the Literature. Mil Med 2023; 188:3692-3695. [PMID: 35894601 DOI: 10.1093/milmed/usac230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/22/2022] [Accepted: 07/20/2022] [Indexed: 11/12/2022] Open
Abstract
Hemobilia is a rare condition defined as bleeding in the biliary tract. The clinical presentation is variable. The typical manifestation consists of jaundice, upper gastrointestinal bleeding, and right upper quadrant abdominal pain. This set of symptoms is known as "Quincke's triad." It is present in only 22%-35% of cases. Post-traumatic hemobilia is an extraordinarily rare condition occurring in only 6% of the patients with hemobilia. In general, it occurs in less than 0.2% of patients with liver trauma. A delay in the development of bleeding after liver trauma is frequent. Early diagnosis is essential because massive bleeding into the biliary tract is a potentially life-threatening condition. We present a case of a patient with massive hemobilia developed 12 days after blunt abdominal trauma. Computed tomography angiography showed two pseudoaneurysms in hepatic segments V and VIII with contrast medium extravasation. We successfully performed digital subtraction angiography with selective transcatheter arterial embolization of the leaking segment VIII pseudoaneurysm. Embolization of the pseudoaneurysm in segment V was technically impracticable. Our article provides a review of the published literature focussing on the prevalence, diagnostics, and treatment of post-traumatic hemobilia.
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Affiliation(s)
- Štěpán-Ota Schütz
- Department of Surgery, Second Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, 16902, Czech Republic
| | - Michael Rousek
- Department of Surgery, Second Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, 16902, Czech Republic
| | - Jiří Pudil
- Department of Surgery, Second Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, 16902, Czech Republic
| | - Pavel Záruba
- Department of Surgery, Second Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, 16902, Czech Republic
| | - Jozef Malík
- Department of Radiology, Military University Hospital Prague, Prague, 16902, Czech Republic
| | - Radek Pohnán
- Department of Surgery, Second Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, 16902, Czech Republic
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9
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Garg T, Khorshidi F, Habibollahi P, Shrigiriwar A, Fang A, Sakiani S, Harfouche M, Diaz JJ, Nezami N. How I Do It: Endovascular Management of Acute Nonvariceal Gastrointestinal Bleeding. Semin Intervent Radiol 2023; 40:475-490. [PMID: 37927517 PMCID: PMC10622246 DOI: 10.1055/s-0043-1775850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fereshteh Khorshidi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Peiman Habibollahi
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Apurva Shrigiriwar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adam Fang
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sasan Sakiani
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Melike Harfouche
- Division Acute Care Surgery, University of South Florida/Tampa General Hospital, Tampa, Florida
| | - Jose J. Diaz
- Division Acute Care Surgery, University of South Florida/Tampa General Hospital, Tampa, Florida
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
- The Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, Colleague Park, Maryland
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10
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Williams T, Maher A, Redmond K, Yeung S, Ko BS. Hemobilia in the setting of cystic artery pseudoaneurysm secondary to type I Mirizzi syndrome. Clin J Gastroenterol 2023:10.1007/s12328-023-01806-w. [PMID: 37131114 DOI: 10.1007/s12328-023-01806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/14/2023] [Indexed: 05/04/2023]
Abstract
Hemobilia is an uncommon diagnosis and is often not suspected in the absence of recent hepatobiliary intervention or trauma. Hemobilia in the setting of cystic artery pseudoaneurysm secondary to type I Mirizzi syndrome is a rare occurrence. We report the case of a 61-year-old male who presented with epigastric pain and vomiting. Blood tests demonstrated hyperbilirubinemia with elevated inflammatory markers. Magnetic resonance cholangiopancreatography revealed type I Mirizzi syndrome in the presence of a 21 mm cystic duct stone. During endoscopic retrograde cholangiopancreatography, hemobilia was identified. Subsequent triple phase computed tomography imaging identified a 12 mm cystic artery pseudoaneurysm. Angiography with successful coiling of the cystic artery was accomplished. Cholecystectomy was performed, confirming type I Mirizzi syndrome. This case demonstrates the importance of considering ruptured pseudoaneurysm in patients presenting with evidence of upper gastrointestinal bleeding in the setting of biliary stone disease. Transarterial embolization, followed by surgical management, is effective in both the diagnosis and management of ruptured cystic artery pseudoaneurysm with associated hemobilia.
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Affiliation(s)
- Thomas Williams
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | - Adrian Maher
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Kendal Redmond
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane, Australia
| | - Shinn Yeung
- Department of Hepatobiliary Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Bong Suk Ko
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia
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11
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Chaudhary SM, Singh A, Chavan M, Das A, Bathvar PK. Uncommon, overlooked and underreported causes of upper gastrointestinal bleeding. Intractable Rare Dis Res 2023; 12:13-21. [PMID: 36873674 PMCID: PMC9976090 DOI: 10.5582/irdr.2022.01128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Upper gastrointestinal bleeding (UGB) is a potentially fatal consequence of digestive disorders. There is a wide range of rare causes for UGB that can lead to misdiagnosis and occasionally catastrophic outcomes. The lifestyles of those who are afflicted are mostly responsible for the underlying conditions that result in the hemorrhagic cases. The development of a novel approach targeted at raising public awareness of the issue and educating the public about it could significantly contribute to the elimination of gastrointestinal bleeding with no associated risks and to a nearly zero mortality rate. There are reports of UGB related to Sarcina ventriculi, gastric amyloidosis, jejunal lipoma, gastric schwannoma, hemobilia, esophageal varices, esophageal necrosis, aortoenteric fistula, homosuccus pancreaticus, and gastric trichbezoar in the literature. The common feature of these rare causes of UGB is that the diagnosis is difficult to establish before surgery. Fortunately, UGB with a clear lesion in the stomach itself is a clear sign for surgical intervention, and the diagnosis can only be verified by pathological examination with the help of immunohistochemical detection of a particular antigen for a specific condition. The clinical traits, diagnostic techniques, and the therapeutic, or surgical options of unusual causes of UGB reported in the literature are compiled in this review.
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Affiliation(s)
| | - Ajay Singh
- Department of General Surgery, Sri Ram MurtiSmarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
- Address correspondence to:Ajay Singh, Department of General Surgery, Sri Ram MurtiSmarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India. E-mail:
| | - Manisha Chavan
- Department of General Surgery, Kakatiya Medical College, RangamPeta, Warangal, Telangana, India
| | - Arghadip Das
- Department of General Surgery, Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
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12
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Endoscopic Ultrasound-Guided Cholecystoenterostomy for Acute Hemorrhagic Cholecystitis Drainage. ACG Case Rep J 2023; 10:e00968. [PMID: 36699185 PMCID: PMC9857378 DOI: 10.14309/crj.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/19/2022] [Indexed: 01/27/2023] Open
Abstract
Hemorrhagic cholecystitis is a rare entity with few cases reported in the literature. We report a case of a 42-year-old man with cirrhosis who presented to the hospital with abdominal pain in the right upper quadrant radiating to the back. Computed tomography scan showed findings consistent with acute cholecystitis. Owing to decompensated cirrhosis, he was not a good candidate for cholecystectomy. Endoscopic ultrasound-guided cholecystoenterostomy was performed that immediately yielded a large amount of old blood with clots along with some bile consistent with acute hemorrhagic cholecystitis. After the drainage, he had an uneventful hospitalization.
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13
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Porto-biliary fistula as an uncommon cause of haemobilia: A case report and literature review. Int J Surg Case Rep 2022; 99:107635. [PMID: 36156458 PMCID: PMC9568702 DOI: 10.1016/j.ijscr.2022.107635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/04/2022] [Accepted: 09/07/2022] [Indexed: 12/03/2022] Open
Abstract
Background Haemobilia is a rare cause of gastrointestinal bleeding. It can be related to iatrogenic injuries, inflammatory diseases, and, more recently, postoperative, or post-procedure complications. Porto-biliary fistula is an uncommon case of haemobilia and has been related to iatrogenic injury or chronic inflammatory processes. To date, less than 30 cases of Porto-biliary fistula have been reported. Case presentation We present a 53 years-old woman with a history of biliary obstruction due to a choledochal cyst that required hepaticojejunostomy with evidence of anastomotic stricture. A percutaneous transhepatic biliary drainage (PTBD) was performed, with 3 failed attempts of percutaneous dilatation. A new hepaticojejunostomy was completed, however, 45 days later the patient presented to the emergency room with haemobilia and secondary hemodynamic instability. An emergency damage control laparotomy was performed, achieving bleeding control. In the second procedure, there is evidence of an ulcerative injury of the biliary tract secondary to a Porto-biliary fistula. Conclusion Porto-biliary fistula is an entity that cannot be ruled out in cases of haemobilia, especially in cases with a history of bile duct surgical or percutaneous procedures. The prognosis is usually good if multidisciplinary management is performed, and the source of the bleeding is identified early. Portobiliary is a rare condition with increased risk of mortality. Clinical suspicion should be present in patients with multiple procedures in the bile tract. Multidisciplinary management increases the rate of successful management. Ureteroscopy could be an alternative to choledocoscopy in emergency context.
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14
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Hemobilia and hemocholecyst as an unusual presentation of gallblader cancer: Report of a case. Int J Surg Case Rep 2022; 99:107712. [PMID: 36261947 PMCID: PMC9568834 DOI: 10.1016/j.ijscr.2022.107712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 11/20/2022] Open
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15
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Niaz M, Khan MA, Muhammad S, Khan AW. Atypical Presentation of Left Hepatic Artery Pseudoaneurysm. ACG Case Rep J 2022; 9:e00815. [PMID: 35784506 PMCID: PMC9246077 DOI: 10.14309/crj.0000000000000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/25/2022] [Indexed: 11/17/2022] Open
Abstract
Hepatic artery pseudoaneurysm (HAP) commonly occurs after trauma and is rarely seen as a complication of pyogenic liver abscess. Patients with HAP can present with hemobilia secondary to arterobiliary fistula. We report a case of a 29-year-old woman who presented with abdominal pain, fever, and jaundice, who was diagnosed to have a pyogenic liver abscess that had led to the development of left HAP, presenting with hemobilia. The patient was successfully managed with endovascular coil embolization.
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Affiliation(s)
- Murk Niaz
- Department of General Surgery, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Muhammad Arsalan Khan
- Department of General Surgery, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Shah Muhammad
- Department of General Surgery, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Abdaal Waseem Khan
- Department of General Surgery, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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Popivanov G, Vladov N, Penchev D, Konaktchieva M, Ilcheva B, Kostadinov R, Nikolov V, Stefanov D, Mutafchiyski V. Two distinct episodes of life-threatening hemobilia due to a lesion of common bile duct and delayed intrapancreatic arteriobiliary fistula managed by emergency pancreatoduodenal resection. Folia Med (Plovdiv) 2022; 64:359-364. [DOI: 10.3897/folmed.64.e62513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/14/2021] [Indexed: 11/12/2022] Open
Abstract
Hemobilia is an extremely rare cause of upper gastrointestinal bleeding. It often has intermittent manifestation, which may lead to significant diagnostic delay. In 65% of the cases, the causes are iatrogenic, in 7% the cause is malignancy, in 5% - gallstones, in 8% it is inflammation (cholecystitis, parasites, reflux cholangitis), vascular abnormality is the cause in 7% (most commonly pseudoaneurysm of the hepatic artery), and pancreatic pseudocyst causes hemobilia in 1%. In almost all cases, the bleeding originates from intrahepatic or extrahepatic bile ducts, and rarely from the pancreas.
PUBMED search with keywords “hemobilia” and “arteriobiliary fistula” found a total of 44 papers. No case with intrapancreatic arterio-biliary fistula was found. To the best of our knowledge, we present a unique case of delayed life-threatening hemobilia caused by intrapancreatic arterio-biliary fistula. It was diagnosed at the fourth admission and managed successfully by emergency Traverso-Longmire pancreatoduodenal resection. We briefly discuss the keys to a timely diagnosis and the cornerstones of the treatment.
The timely diagnosis of hemobilia depends on a high index of suspicion and careful interpretation of the symptoms. Hemodynamic stability has a crucial role in the decision-making process. Angioembolization is the cornerstone of the treatment, whereas surgery is reserved only for cases with an unstable hemodynamic or unsuccessful embolization. Surgical approach depends on the bleeding site. Although an emergency pancreatic head resection is a procedure of last resort, it can be life-saving in cases with intractable bleeding due to intrapancreatic arteriobiliary fistula.
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Tsai YH, Chang HM. Post-Cholecystectomy Right Hepatic Artery Pseudoaneurysm Induced by Generalized Seizure: A Case Report. Medicina (B Aires) 2022; 58:medicina58050568. [PMID: 35629985 PMCID: PMC9144900 DOI: 10.3390/medicina58050568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Pseudoaneurysm is a rare complication of laparoscopic cholecystectomy (LC). In most cases, the patient presents with gastrointestinal bleeding or hemoperitoneum. Here, we present a case with a post-cholecystectomy right hepatic artery pseudoaneurysm (PSA) induced by a generalized seizure. A 39-year-old male was sent to the emergency room with a generalized seizure and a loss of consciousness for approximately 5 min. Diffuse abdominal pain was complained of after consciousness returned. The surgical history of LC 13 days prior was mentioned. Abdominal computer tomography (CT) revealed a lobulated fluid accumulation in the gallbladder fossa with prominent fatty stranding and suspected biloma formation. After admission for one week, sharp abdominal pain was observed. Abdominal CT angiography revealed a right hepatic artery pseudoaneurysm. Transcatheter arterial embolization was performed with a total of seven platinum coils. In conclusion, it is important for doctors to take pseudoaneurysm into consideration in the patient who presents with seizure attack after receiving LC. Late discovery of PSA when it is ruptured can lead to fatal conditions, such as severe hemoperitoneum.
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Affiliation(s)
- Yueh-Hsun Tsai
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Hao-Ming Chang
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence:
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Cholangioscopic diagnosis of hemobilia: an unusual case of left hepatic portal hypertension by plasma cell tumor. VideoGIE 2022; 7:143-145. [PMID: 35937199 PMCID: PMC9347177 DOI: 10.1016/j.vgie.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Anamah BC, Torres MB, Rose BJ, Huang J. External tamponade of pseudoaneurysm with balloon catheter. Radiol Case Rep 2022; 17:537-539. [PMID: 34976260 PMCID: PMC8688938 DOI: 10.1016/j.radcr.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Brandon C. Anamah
- School of Medicine, Meharry Medical College, Nashville, TN, USA
- Corresponding author.
| | | | - Bart J. Rose
- Division of Surgical Oncology, University of Alabama, Birmingham, AL, USA
| | - Junjian Huang
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Scarola S, Sibia US, Gibson G. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac202. [PMID: 35557852 PMCID: PMC9090512 DOI: 10.1093/jscr/rjac202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/16/2022] [Indexed: 11/25/2022] Open
Abstract
Gallbladder adenocarcinoma is a rare gastrointestinal malignancy and is associated with a poor prognosis. These malignancies are most often discovered incidentally in \documentclass[12pt]{minimal}
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}{}$\sim$\end{document}1% of all cholecystectomy procedures. We report an 80-year-old male patient with iron deficiency anemia, who underwent an unremarkable endoscopy and colonoscopy, and was subsequently found to have hemobilia discovered on capsule endoscopy. Magnetic resonance cholangiopancreatography revealed a space-occupying process involving the posterior wall of the gallbladder. The patient underwent an unremarkable laparoscopic cholecystectomy with final pathology revealing a well-differentiated, 8 cm intracystic papillary neoplasm with high-grade dysplasia involving the majority of the gallbladder, with focally invasive adenocarcinoma invading the muscular layer of the gallbladder wall. Postoperative staging work-up revealed no evidence of metastatic disease. Patient then underwent a radical resection of segments 4B/5 of the gallbladder fossa and lymph node resection of the porta hepatis. Final pathology revealed Stage I adenocarcinoma of the gallbladder (T1bNxM0).
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Affiliation(s)
- Samantha Scarola
- Liberty University College of Osteopathic Medicine, School of Medicine, 306 Liberty View Ln, Lynchburg, VA 24502
| | - Udai S Sibia
- Anne Arundel Medical Center at Luminis Health, Department of Surgery, 2003 Medical Parkway, Suite 301, Annapolis, 21401
| | - Glen Gibson
- Correspondence address. Anne Arundel Medical Center at Luminis Health, 2003 Medical Parkway, Suite 301, Annapolis, 21401, USA. E-mail: ; Tel: 443-481-3717
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21
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Cystic Artery Pseudoaneurysm: Current Review of Aetiology, Presentation, and Management. Surg Res Pract 2021; 2021:4492206. [PMID: 34869829 PMCID: PMC8635945 DOI: 10.1155/2021/4492206] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/28/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background Cystic artery pseudoaneurysms are rare. Most commonly, they occur secondary to acute cholecystitis or after a cholecystectomy. Complications include haemobilia, biliary obstruction, and haemorrhage. Given the rarity and associated morbidity, a high index of suspicion is required. This article reviews the current literature on cystic artery pseudoaneurysms to investigate its aetiology, clinical presentation, and management options. Methods A broad search of the Medline and PubMed databases was carried through. All peer reviewed literatures published in the English language between 1991 and 2020 with keywords "cystic" and "artery" and "pseudoaneurysm" in the title were selected for review. No further exclusion criteria; all studies yielded from the search were included in the results of this review. Additionally, we present a case of cystic artery pseudoaneurysm treated at our centre and included this in our analysis. Results Sixty-seven case reports were found between 1991 and 2020. Aetiologies: Aetiology of cystic artery pseudoaneurysm was found to be cholecystitis in 41 instances (61.2%), cholecystectomy in 18 instances (26.8%), idiopathic in 6 instances (8.9%) cholelithiasis in 1 instance (1.5%), and pancreatitis in 1 instance (1.5%). Complications: Fifty-two cases were complicated by haemobilia (77.6%), 36 by anaemia (53.7%), 25 by biliary obstruction (37.3%), 13 by haemodynamic shock (19.4%), 9 by haemoperitoneum (13.4%), and 6 by contained rupture (8.9%). Most commonly, patients had two or more of these complications. Management: Forty-four patients were managed with endovascular embolisation (65.7%), 21 with endoscopic intervention (31.3%), 18 with open cholecystectomy (26.9%), 13 with laparoscopic cholecystectomy (19.4%), and 6 with pseudoaneurysm ligation (9%). Delayed presentation postcholecystectomy ranged from 8 days to 3 years. Conclusions Cystic artery pseudoaneurysms are rare complications of a common operation. The most common clinical presentation is haemobilia, which can be difficult to diagnose clinically. A high index of suspicion and prompt investigation with targeted imaging and intervention is required. This is especially pertinent in gastrointestinal bleeding postlaparoscopic cholecystectomy as a missed diagnosis could cause significant morbidity.
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22
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A Resected Primary Angiosarcoma of the Pancreas Presenting Aggressive Metastatic Liver Recurrence with Uncontrollable Intra-abdominal Bleeding: a Case Report. J Gastrointest Cancer 2021; 53:1124-1129. [PMID: 34648135 DOI: 10.1007/s12029-021-00727-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
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Shishido Y, Fujimoto K, Yano Y, Mitsuoka E, Komatsubara T, Shio S, Ishii M, Higashiyama H. Emergency surgery for hemobilia due to hepatic artery pseudoaneurysm rupture complicated by Mirizzi syndrome type II: a case report. BMC Surg 2021; 21:318. [PMID: 34353316 PMCID: PMC8340468 DOI: 10.1186/s12893-021-01314-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/30/2021] [Indexed: 01/06/2023] Open
Abstract
Background Hemobilia refers to bleeding into the biliary tract. Hepatic artery pseudoaneurysm (HAP) rupture is an uncommon cause of hemobilia, and cases of HAP associated with Mirizzi syndrome are extremely rare. Although transarterial embolization is recommended as the first-line treatment for hemobilia, surgery is sometimes required. Case presentation A 76-year-old woman was referred to our hospital with epigastric pain. She was febrile and had conjunctival icterus and epigastric tenderness. Laboratory tests revealed abnormal white blood cell count and liver function. An abdominal computed tomography (CT) revealed multiple calculi in the gallbladder, an incarcerated calculus in the cystic duct, and a slightly dilated common hepatic duct. Based on examination findings, she was diagnosed with Mirizzi syndrome type I, complicated by cholangitis. Intravenous antibiotics were administered, and we performed endoscopic retrograde cholangiopancreatography (ERCP) to place a drainage tube. The fever persisted; therefore, contrast-enhanced CT (CECT) was performed. This revealed portal vein thrombosis and hepatic abscesses; therefore, heparin infusion was administered. The following day, she complained of melena, and laboratory tests showed that she was anemic. ERCP was performed to change the drainage tube in the bile duct; however, bleeding from the papilla of Vater was observed. CECT demonstrated a right HAP with high-density fluid in the gallbladder and gallbladder perforation. Finally, she was diagnosed with hemobilia caused by HAP rupture, and emergency surgery was performed to secure hemostasis and control the infection. During laparotomy, we found that a right HAP had ruptured into the gallbladder. The gallbladder made a cholecystobiliary fistula, which indicated Mirizzi syndrome type II. Although we tried to repair the right hepatic artery, we later ligated it due to arterial wall vulnerability. Then, we performed subtotal cholecystectomy and inserted a T-tube into the common bile duct. There were no postoperative complications except for minor leakage from the T-tube insertion site. The patient was discharged after a total hospital stay of 7 weeks. Conclusions We experienced an extremely rare case of emergency definitive surgery for hemobilia due to HAP rupture complicated by Mirizzi syndrome type II. Surgery might be indicated when controlling underlying infections was required.
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Affiliation(s)
- Yutaka Shishido
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, Hyogo, 6510072, Japan.
| | - Koji Fujimoto
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, Hyogo, 6510072, Japan
| | - Yasumichi Yano
- Department of Gastroenterology, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, Hyogo, 6510072, Japan
| | - Eisei Mitsuoka
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, Hyogo, 6510072, Japan
| | - Takashi Komatsubara
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, Hyogo, 6510072, Japan
| | - Seiji Shio
- Department of Gastroenterology, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, Hyogo, 6510072, Japan
| | - Masayuki Ishii
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, Hyogo, 6510072, Japan
| | - Hiroshi Higashiyama
- Department of Gastrointestinal Surgery, Shinko Hospital, 1-4-47, Wakinohama-cho, Chuo-ku, Kobe, Hyogo, 6510072, Japan
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Francica G, Meloni MF, Riccardi L, Giangregorio F, Caturelli E, Terracciano F, de Sio I. Role of Contrast-Enhanced Ultrasound in the Detection of Complications After Ultrasound-Guided Liver Interventional Procedures. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1665-1673. [PMID: 33085814 DOI: 10.1002/jum.15540] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/26/2020] [Accepted: 09/29/2020] [Indexed: 06/11/2023]
Abstract
The role of contrast-enhanced ultrasound (CEUS) in interventional ultrasound-guided procedures in the liver has been increasingly recognized. However, little is known about the capability of CEUS for diagnosing complications after liver biopsy and ablation with special regard to postprocedural hemorrhage. The aim of this Pictorial Essay is to present the CEUS features of a wide spectrum of vascular complications (with or without bleeding) and injuries of the surrounding abdominal and chest wall occurring after liver interventional procedures.
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Affiliation(s)
- Giampiero Francica
- Unità di Ecografia Interventistica, Pineta Grande Hospital, Castel Volturno, Italy
| | - Maria Franca Meloni
- Servizio di Radiologia, Casa di Cura Igea, Milan, Italy
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Laura Riccardi
- Medicina e Interna e Gastroenterologia, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | | | | | - Fulvia Terracciano
- Gastroenterologia, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Ilario de Sio
- Epatogastroenterologia, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
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Berry R, Weissman S, Mehta TI, Vartanian T, Tabibian JH. Hemobilia in the Setting of Billroth II Anatomy and Recurrent Gastric Adenocarcinoma. J Gastrointest Cancer 2021; 52:328-331. [PMID: 32572812 DOI: 10.1007/s12029-020-00437-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rani Berry
- Department of Internal Medicine, UCLA Ronald Reagan Medical Center, Los Angeles, CA, USA
| | - Simcha Weissman
- Department of Medicine, Hackensack University-Palisades Medical Center, North Bergen, NJ, USA
| | - Tej I Mehta
- Department of Radiology, University of South Dakota, Sioux Falls, SD, USA
| | - Tara Vartanian
- Department of Internal medicine, Adventist Health White Memorial, Los Angeles, CA, USA
| | - James H Tabibian
- Division of Gastroenterology, Olive View-UCLA Medical Center, 14445 Olive View Dr., 2B-182, Sylmar, CA, 91342, USA.
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Minezaki S, Misawa T, Watanabe M, Takahashi H, Koenuma T, Kondo R, Toyoda H, Nemoto K, Tsukayama H, Shibuya M, Wada K, Sano K, Ohta Y, Numakura S, Sasajima Y, Uozaki H. A case with massive hemobilia long-term after internal drainage surgery for congenital biliary dilation. Surg Case Rep 2021; 7:157. [PMID: 34232428 PMCID: PMC8263832 DOI: 10.1186/s40792-021-01242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, there is an unwavering consensus that the standard surgery for congenital biliary dilation (CBD) is extrahepatic bile duct resection and choledochojejunostomy. However, decades prior, choledochocyst-gastrointestinal anastomosis without extrahepatic bile duct resection (internal drainage surgery, IDS) was preferred for CBD because of its simplicity. Currently, there is almost no chance of a surgeon encountering a patient who has undergone old-fashioned IDS, which has been completely obsolete due to the risk of carcinogenesis from the remaining bile duct. Moreover, the pathological condition long after IDS is unclear. Herein, we report a case of life-threatening bile duct bleeding as well as carcinoma of the bile duct 62 years after IDS in a patient with CBD. CASE PRESENTATION An 82-year-old Japanese woman with hemorrhagic shock due to gastrointestinal bleeding was transferred to our hospital. She had a medical history of unspecified surgery for CBD at the age of 20. Based on imaging findings and an understanding of the historical transition of the surgical procedure for CBD, the cause of gastrointestinal bleeding was determined to be rupture of the pseudoaneurysm of the dilated bile duct that remained after IDS. Hemostasis was successfully performed by transcatheter arterial embolization (TAE) in an emergency setting. Then, elective surgery for extrahepatic bile duct resection and choledochojejunostomy was performed to prevent rebleeding. Pathological examination revealed severely and chronically inflamed mucosa of the bile duct. Additionally, cholangiocarcinoma (Tis, N0, M0, pStage 0) was incidentally revealed. CONCLUSION It has been indicated that not only carcinogenesis, but also a risk of life-threatening bleeding exists due to long-lasting chronic inflammation to the remnant bile duct after IDS for CBD. Additionally, both knowledge of which CBD operation was performed, and an accurate clinical history are important for the diagnosis of hemobilia.
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Affiliation(s)
- Shunryo Minezaki
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Takeyuki Misawa
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan.
| | - Makoto Watanabe
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Hideki Takahashi
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Takashi Koenuma
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Rie Kondo
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Hiroe Toyoda
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Kentaro Nemoto
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Hiroyuki Tsukayama
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Makoto Shibuya
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Yasunori Ohta
- Department of Pathology, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Satoe Numakura
- Department of Pathology, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Yuko Sasajima
- Department of Pathology, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Hiroshi Uozaki
- Department of Pathology, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
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Kurniawan K, Wibawa IDN, Somayana G, Mariadi IK, Mulyawan IM. Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report. J Med Case Rep 2021; 15:331. [PMID: 34210350 PMCID: PMC8252212 DOI: 10.1186/s13256-021-02915-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/18/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hemobilia is a rare cause of upper gastrointestinal bleeding that originates from the biliary tract. It is infrequently considered in diagnosis, especially in the absence of abdominal trauma or history of hepatopancreatobiliary procedure, such as cholecystectomy, which can cause arterial pseudoaneurysm. Prompt diagnosis is crucial because its management strategy is distinct from other types of upper gastrointestinal bleeding. Here, we present a case of massive hemobilia caused by the rupture of a gastroduodenal artery pseudoaneurysm in a patient with a history of laparoscopic cholecystectomy 3 years prior to presentation. CASE PRESENTATION A 44-year-old Indonesian female presented to the emergency department with complaint of hematemesis and melena accompanied by abdominal pain and icterus. History of an abdominal trauma was denied. However, she reported having undergone a laparoscopic cholecystectomy 3 years prior to presentation. On physical examination, we found anemic conjunctiva and icteric sclera. Nonvariceal bleeding was suspected, but esophagogastroduodenoscopy showed a blood clot at the ampulla of Vater. Angiography showed contrast extravasation from a gastroduodenal artery pseudoaneurysm. The patient underwent pseudoaneurysm ligation and excision surgery to stop the bleeding. After surgery, the patient's vital signs were stable, and there was no sign of rebleeding. CONCLUSION Gastroduodenal artery pseudoaneurysm is a rare complication of laparoscopic cholecystectomy. The prolonged time interval, as compared with other postcholecystectomy hemobilia cases, resulted in hemobilia not being considered as an etiology of the gastrointestinal bleeding at presentation. Hemobilia should be considered as a possible etiology of gastrointestinal bleeding in patients with history of cholecystectomy, regardless of the time interval between the invasive procedure and onset of bleeding.
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Affiliation(s)
- Kurniawan Kurniawan
- Department of Internal Medicine, Faculty of Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - I Dewa Nyoman Wibawa
- Gastroentero-Hepatology Division, Department of Internal Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - Gde Somayana
- Gastroentero-Hepatology Division, Department of Internal Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - I Ketut Mariadi
- Gastroentero-Hepatology Division, Department of Internal Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia.
| | - I Made Mulyawan
- Digestive Surgery Division, Department of General Surgery, Faculty of Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia
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Gao X, de Jonge J, Verhagen H, Dinkelaar W, Ten Raa S, van Rijn MJ. Unsuccessful Stent Graft Repair of a Hepatic Artery Aneurysm Presenting with Haemobilia: Case Report and Comprehensive Literature Review. EJVES Vasc Forum 2021; 52:30-36. [PMID: 34382030 PMCID: PMC8339217 DOI: 10.1016/j.ejvsvf.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/31/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022] Open
Abstract
Aims To discuss treatment strategies for non-traumatic, non-iatrogenic hepatic artery aneurysms (HAAs) in the presence of an arteriobiliary fistula, illustrated by a case and followed by a comprehensive review of the literature. Methods Following the PRISMA guidelines, 24 eligible HAA cases presenting with haemobilia were identified. Characteristics of patients, aneurysms, treatment strategies and their outcomes were collected. Results A 69 year old patient with no previous hepatobiliary intervention or trauma, presented with jaundice and haemobilia caused by a HAA. Initial treatment by endovascular stenting was chosen to prevent ischaemic liver complications. Unfortunately, this strategy failed because of stent migration due to ongoing infection leading to a type 1A endoleak. The patient had to be converted to open surgery with ligation of the HAA. The patient recovered uneventfully and no complications occurred during the following 12 months. Comprehensive literature review Of the 24 cases, nine had a true HAA and 15 were pseudo/mycotic aneurysms, mainly caused by endocarditis or cholecystitis. The majority were located in the right hepatic artery. In 20 cases, an endovascular first approach was chosen with embolisation, none with covered stents. Three of these cases had to be converted to open surgery because of rebleeding. In all open (primary or secondary) cases, ligation of the HAA was performed. One patient in these series died. No liver ischaemia or abscesses were reported, although one patient developed an ischaemic gallbladder. Conclusions Patients who present with a HAA and haemobilia may be treated safely by embolisation or open ligation. Using a covered stent graft in these patients can cause problems due to ongoing infection and should be monitored closely by imaging. Publication bias and lack of long term follow up imply cautious interpretation of these findings. In patients presenting with haemobilia in the presence of a non-traumatic and non-iatrogenic hepatic artery aneurysmEndocarditis and cholecystitis are the most common causes The main treatment modality is embolisation Liver ischaemia and liver abscesses have not been reported after treatment Close surveillance is recommended as the area has to be considered contaminated Treatment should be performed by a multidisciplinary team
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Affiliation(s)
- Xing Gao
- Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jeroen de Jonge
- Department of Hepatobiliary and Transplantation Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Hence Verhagen
- Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Wouter Dinkelaar
- Department of Interventional Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sander Ten Raa
- Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Marie Josee van Rijn
- Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
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Sakharuk I, Martinez P, Laub M, Gani I, Saeed M. Anticoagulant-induced hemorrhagic cholecystitis with hemobilia after deceased donor kidney transplant and literature review. Int J Surg Case Rep 2021; 84:106027. [PMID: 34118559 PMCID: PMC8196047 DOI: 10.1016/j.ijscr.2021.106027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance Hemobilia and hemorrhagic cholecystitis are uncommon causes of right upper quadrant abdominal pain. The development of intra-gallbladder and biliary bleeding has been primarily associated with abdominal trauma, malignancy, liver transplant, and iatrogenic injury to the biliary tree and vasculature. Spontaneous anticoagulant induced hemorrhagic cholecystitis and hemobilia are incredibly rare events and have only been documented by a handful of case reports. Case presentation A 55-year-old male who had recently undergone a deceased-donor kidney transplant was transferred to our academic institution for evaluation of subjective fever, right upper quadrant abdominal and back pain. The patient demonstrated localized tenderness in the right abdomen and was found to have hemorrhagic cholecystitis on imaging. He subsequently underwent urgent cholecystectomy and recovered without any subsequent complications. Clinical discussion Hemorrhagic cholecystitis and hemobilia are a rare cause of right-sided or generalized abdominal pain. Diagnosis is made primarily by pathognomonic findings on CT and US imaging. Prompt diagnosis is essential in preventing mortality and/or significant morbidity. The standard treatment consists of urgent/emergent cholecystectomy. Conclusion A rare sequelae of anticoagulant use, intra-biliary bleeding must be considered as a differential diagnosis in anticoagulated patients presenting with right upper quadrant abdominal pain. Hemorrhagic cholecystitis is uncommon cause of right upper quadrant abdominal pain Spontaneous anticoagulant induced hemorrhagic cholecystitis have only been reported by a handful of case reports. Patients experiencing intra-gallbladder bleeding often present with symptoms similar to those seen in acute cholecystitis.
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Affiliation(s)
- Ilya Sakharuk
- Augusta University, Department of Surgery, United States of America
| | | | - Melissa Laub
- Augusta University, Department of Pharmacy, United States of America
| | - Imran Gani
- Augusta University, Department of Medicine, United States of America
| | - Muhammad Saeed
- Augusta University, Department of Surgery, United States of America.
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Parvinian A, Fletcher JG, Storm AC, Venkatesh SK, Fidler JL, Khandelwal AR. Challenges in Diagnosis and Management of Hemobilia. Radiographics 2021; 41:802-813. [PMID: 33939540 DOI: 10.1148/rg.2021200192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hemobilia, or hemorrhage within the biliary system, is an uncommon form of upper gastrointestinal (GI) bleeding that presents unique diagnostic and therapeutic challenges. Most cases are the result of iatrogenic trauma, although accidental trauma and a variety of inflammatory, infectious, and neoplastic processes have also been implicated. Timely diagnosis can often be difficult, as the classic triad of upper GI hemorrhage, biliary colic, and jaundice is present in a minority of cases, and there may be considerable delay in the onset of bleeding after the initial injury. Therefore, the radiologist must maintain a high index of suspicion for this condition and be attuned to its imaging characteristics across a variety of modalities. CT is the first-line diagnostic modality in evaluation of hemobilia, while catheter angiography and endoscopy play vital and complementary roles in both diagnosis and treatment. The authors review the clinical manifestations and multimodality imaging features of hemobilia, describe the wide variety of underlying causes, and highlight key management considerations.©RSNA, 2021.
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Affiliation(s)
- Ahmad Parvinian
- From the Departments of Radiology (A.P., J.G.F., S.K.V., J.L.F., A.R.K.) and Gastroenterology (A.C.S.), Mayo Clinic, 200 First St SW, Rochester MN 55905
| | - Joel G Fletcher
- From the Departments of Radiology (A.P., J.G.F., S.K.V., J.L.F., A.R.K.) and Gastroenterology (A.C.S.), Mayo Clinic, 200 First St SW, Rochester MN 55905
| | - Andrew C Storm
- From the Departments of Radiology (A.P., J.G.F., S.K.V., J.L.F., A.R.K.) and Gastroenterology (A.C.S.), Mayo Clinic, 200 First St SW, Rochester MN 55905
| | - Sudhakar K Venkatesh
- From the Departments of Radiology (A.P., J.G.F., S.K.V., J.L.F., A.R.K.) and Gastroenterology (A.C.S.), Mayo Clinic, 200 First St SW, Rochester MN 55905
| | - Jeff L Fidler
- From the Departments of Radiology (A.P., J.G.F., S.K.V., J.L.F., A.R.K.) and Gastroenterology (A.C.S.), Mayo Clinic, 200 First St SW, Rochester MN 55905
| | - Ashish R Khandelwal
- From the Departments of Radiology (A.P., J.G.F., S.K.V., J.L.F., A.R.K.) and Gastroenterology (A.C.S.), Mayo Clinic, 200 First St SW, Rochester MN 55905
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L Chandrananth M, Cullinan M. A rare cause of hemobilia: Metastatic melanoma of the gallbladder. INTERNATIONAL JOURNAL OF HEPATOBILIARY AND PANCREATIC DISEASES 2020. [DOI: 10.5348/100091z04mc2020ci] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction: Gallbladder melanoma is an extremely rare entity, even more so in living patients, as many remain asymptomatic. Patients usually present with symptoms resembling acute cholecystitis, however here we present a case of metastatic melanoma of the gallbladder presenting with hemobilia.
Case Report: An 82-year-old lady with a history of skin cancer excisions, including melanoma, many years ago, presented with anemia of unknown origin. A computed tomography (CT) scan was performed, demonstrating a gallbladder mass and hemobilia. She successfully underwent open cholecystectomy, partial liver resection, and lymph node dissection, which on histopathology, demonstrated metastatic melanoma. She remains disease free eight months later.
Conclusion: Although melanoma of the gallbladder is rare, in patients with a past history of melanoma, a high index of suspicion should be maintained if there are concerning signs, such as anemia, without a clear cause. With early identification and surgical intervention, a patient’s survival rate can be optimized.
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Affiliation(s)
- Meera L Chandrananth
- MD, Biomed, Surgical Registrar, Department of General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Mark Cullinan
- MBBS, FRACS, Hepato-Pancreato-Biliary and Upper Gastrointestinal Surgeon, General Surgery and Gastroenterology Clinical Institute, Epworth Health-Care, Melbourne, Victoria, Australia; Department of Surgery, Monash University, Melbourne, Victoria, Australia; Department of Surgery, Monash Medical Centre, Melbourne, Victoria, Australia
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Yoshida K, Umeda Y, Iwamuro M, Matsumoto K, Kato H, Uka M, Matsui Y, Yoshida R, Kuise T, Yasui K, Takagi K, Araki H, Yagi T, Fujiwara T. Hemobilia after bile duct resection: perforation of pseudoaneurysm into intra-pancreatic remnant bile duct: a case report. BMC Surg 2020; 20:307. [PMID: 33261613 PMCID: PMC7709292 DOI: 10.1186/s12893-020-00981-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemobilia occurs mainly due to iatrogenic factors such as impairment of the right hepatic or cystic artery, and/or common bile duct in hepatobiliary-pancreatic surgery. However, little or no cases with hemobilia from the intra-pancreatic remnant bile duct after bile duct resection (BDR) has been reported. Here, we report a case of massive hemobilia due to the perforation of psuedoaneurysm of the gastroduodenal artery (GDA) to the intra-pancreatic remnant bile duct after hepatectomy with BDR. CASE PRESENTATION A 68-year-old male underwent extended right hepatectomy with BDR for gallbladder carcinoma. He presented with upper gastrointestinal bleeding 2 months after the initial surgery. Upper endoscopy identified a blood clot from the ampulla of Vater and simultaneous endoscopic balloon tamponade contributed to temporary hemostasis. Abdominal CT and angiography revealed a perforation of the psuedoaneurysm of the GDA to the intra-pancreatic remnant bile duct resulting in massive hemobilia. Subsequent selective embolization of the pseudoaneurysm with micro-coils could achieve complete hemostasis. He survived without any recurrence of cancer and bleeding. CONCLUSION Hemobilia could occur in a patient with BDR due to perforation of the pseudoaneurysm derived from the GDA to the intra-pancreatic remnant bile duct. Endoscopic balloon tamponade was useful for a temporal hemostasis and a subsequent radiologic interventional approach.
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Affiliation(s)
- Kazuhiro Yoshida
- Department of Gastroenterological Surgery and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama city, Okayama, 7000914, Japan
| | - Yuzo Umeda
- Department of Gastroenterological Surgery and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama city, Okayama, 7000914, Japan.
| | - Masaya Iwamuro
- Gastroenterology and Hepatology Department, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuyuki Matsumoto
- Gastroenterology and Hepatology Department, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hironari Kato
- Gastroenterology and Hepatology Department, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryuichi Yoshida
- Department of Gastroenterological Surgery and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama city, Okayama, 7000914, Japan
| | - Takashi Kuise
- Department of Gastroenterological Surgery and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama city, Okayama, 7000914, Japan
| | - Kazuya Yasui
- Department of Gastroenterological Surgery and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama city, Okayama, 7000914, Japan
| | - Kosei Takagi
- Department of Gastroenterological Surgery and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama city, Okayama, 7000914, Japan
| | - Hiroyuki Araki
- Department of Gastroenterological Surgery and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama city, Okayama, 7000914, Japan
| | - Takahito Yagi
- Department of Gastroenterological Surgery and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama city, Okayama, 7000914, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama city, Okayama, 7000914, Japan
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Traa AC, Hoven-Gondrie ML, Diederik AL. A pseudoaneurysm of the right hepatic artery treated successfully with a stent graft - A case report. Int J Surg Case Rep 2020; 77:407-411. [PMID: 33220658 PMCID: PMC7688995 DOI: 10.1016/j.ijscr.2020.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 10/27/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022] Open
Abstract
Haemobilia caused by pseudoaneurysms of the right hepatic artery or the cystic artery are rare with incidences up to 0.6%. Pathogenesis of pseudoaneurysms of the cystic or hepatic arteries are described to be cholecystectomy or cholecystitis related. Embolization is considered the golden standard. However, stent grafts should be considered a minimal invasive and effective alternative after failed embolization in pseudoaneurysms.
Introduction Haemobilia caused by pseudoaneurysms of the right hepatic or cystic artery is rare. Haemobilia classically causes gastro-intestinal hemorrhage, jaundice and upper abdominal pain. Presentation of case A 76-year old female underwent laparoscopic cholecystectomy because of a severe acute on chronic cholecystitis. A massive arterial bleeding occurred during surgery, which was controlled with hemoclips. Approximately one week after surgery the patient developed severe colic pains and cholestatic liver enzyme alterations. Endo-ultrasound showed normal-width bile ducts, however during a subsequent ERCP haemobilia was observed. On computed tomography a pseudoaneurysm of the right hepatic artery was seen. Selective embolization was initially successful, however, a rebleed was observed two weeks later and a 6 × 50 mm Viabahn stent graft was placed in the right hepatic artery uneventfully. The patient remained free of complaints during 3-years of follow-up. Discussion Pseudoaneurysms of the cystic or hepatic arteries are described to be cholecystectomy or cholecystitis related. The etiology of the pseudoaneurysm in this case can be inflammatory or iatrogenic. Embolization is the golden standard in pseudoaneurysm treatment. Stent graft implantation has not been frequently described as an alternative option to surgery after a failed attempt of embolization. Conclusion This case report presents a probable cholecystitis related pseudoaneurysm of the right hepatic artery, which caused haemobilia after cholecystectomy. The pseudoaneurysm was successfully eliminated with a stent graft after embolization had failed. Stent grafts should be considered a minimal invasive and effective alternative after failed embolization of a pseudoaneurysm.
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Affiliation(s)
- Amber C Traa
- Department of Surgery, Gelderse Vallei Hospital, Ede, the Netherlands.
| | | | - Arjen L Diederik
- Department of Radiology, Gelderse Vallei Hospital, Ede, the Netherlands
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Ng HHL, Ling L, Lodge P, Hammond C, Wah TM. Mycotic pseudoaneurysm of the hepatic artery as a complication of radiofrequency ablation of hepatic metastases. Radiol Case Rep 2020; 15:2663-2667. [PMID: 33101562 PMCID: PMC7575651 DOI: 10.1016/j.radcr.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/25/2022] Open
Abstract
Image-guided radiofrequency ablation is frequently used to treat small hepatocellular carcinoma and metastases. Complications associated with this thermal-based technology for liver cancers arise via direct mechanical injury by the electrodes or collateral thermal damage to surrounding structures. This case report describes an unusual presentation of hepatic arterial mycotic pseudoaneurysm as melaena after percutaneous image-guided radiofrequency ablation for liver metastases in a patient with a previous surgical history of hepaticojejunostomy for cholangiocarcinoma. The patient had a lifesaving procedure to treat the hepatic pseudoaneurysm with transarterial glue embolization.
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Affiliation(s)
- Helen Hoi Lam Ng
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, England
| | - Lynn Ling
- Department of Radiology, Hull University Teaching Hospitals NHS Trust, Hull, England
| | - Peter Lodge
- Department of HPB and Transplant Surgery, St. James's University Hospital, Leeds Teaching Hospital Trust, Leeds, England
| | - Christopher Hammond
- Department of Vascular Interventional Radiology, Leeds Teaching Hospital Trust, Leeds, England
| | - Tze Min Wah
- Department of Diagnostic and Interventional Radiology, Institute of Oncology, St. James's University Hospital, Leeds Teaching Hospitals Trust, Leeds, England
- Corresponding author.
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Lingala S, Tian M, Urayama S. An Elusive Cause of Recurrent Obstructive Jaundice Post-ERCP and Cholecystectomy. Am J Med Sci 2020; 361:398-399. [PMID: 33012485 DOI: 10.1016/j.amjms.2020.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/19/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Shilpa Lingala
- Department of Internal Medicine, Department of Gastroenterology and Hepatology, University of California Davis Medical Center, Sacramento, California.
| | - Miao Tian
- Department of Pathology, University of California Davis Medical Center, Sacramento, California
| | - Shiro Urayama
- Department of Internal Medicine, Department of Gastroenterology and Hepatology, University of California Davis Medical Center, Sacramento, California
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Upper Gastrointestinal Bleeding With Hemobilia Caused by Gallstones. J Emerg Med 2020; 58:e227-e229. [PMID: 32354592 DOI: 10.1016/j.jemermed.2020.03.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/06/2020] [Accepted: 03/18/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hemobilia refers to bleeding in the biliary tract, commonly due to iatrogenic, traumatic, and neoplastic causes. It is a rare source of upper gastrointestinal hemorrhage, but it can be severe and fatal. However, gallstones account for 5%-15% of hemobilia cases. CASE REPORT A 60-year-old woman with diabetes mellitus and chronic kidney disease visited the emergency department with complaints of epigastric pain and vomiting of coffee ground-like content for 2 days. Physical examination revealed epigastric tenderness and hyperactive bowel sounds. Laboratory tests showed anemia with a hemoglobin count of 10.7 mg/dL and elevated liver function tests with total and direct bilirubin levels of 3.6 mg/dL and 2.5 mg/dL, respectively. Panendoscopy showed oozing of coffee ground-like material at the orifice of the ampulla of Vater and second portion of the duodenum, leading to suspicion of hemobilia. After admission, endoscopic retrograde cholangiopancreatography revealed common bile duct (CBD) dilatation with choledocholithiasis, biliary sludge, and filling defect at the middle section of the CBD. Endoscopic sphincterotomy with balloon lithotripsy was performed. After biliary decompression and broad-spectrum antibiotic administration, abdominal pain was relieved, and liver enzyme and total bilirubin levels improved. Symptoms of hemobilia depend on the bleeding rate and presence of bile duct obstructions due to clots. Minor and slow bleeding tend to form clots and cause biliary obstruction. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although minor hemobilia may remain asymptomatic and tends to resolve spontaneously, the cause of hemobilia must be corrected to prevent recurrent bleeding or obstruction.
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Prasad A, Prasad A, Kumar P, Kumar S. Post-traumatic Pseudoaneurysm of Hepatic Artery: An Unusual Cause of Upper Gastrointestinal Bleeding. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1796-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Proença AL, Veloso Gomes F, Costa N, Bilhim T, Luz JH, Coimbra É. Transarterial Embolization of Iatrogenic Cystic Artery Pseudoaneurysm. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 27:115-118. [PMID: 32266308 DOI: 10.1159/000501400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/07/2019] [Indexed: 12/26/2022]
Abstract
Cystic artery pseudoaneurysm (CAP) is a rare entity most often resulting from inflammatory conditions (acute cholecystitis or pancreatitis) or iatrogenic trauma (cholecystectomy). We report the case of a 73-year-old female who presented with abdominal pain and gastrointestinal bleeding after an episode of acute cholecystitis and endoscopic retrograde cholangiopancreatography for choledocolithiasis removal. Computed tomography and angiography revealed a CAP measuring 5 cm. A right hepatic artery transcatheter embolization was performed with glue, excluding the pseudoaneurysm. The next day, the patient underwent open cholecystectomy with ligation of the cystic artery. Later, ischemic hepatitis and abscess developed.
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Affiliation(s)
- Ana Luísa Proença
- Interventional Radiology Unit, Hepato-Biliary-Pancreatic and Transplant Center, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Filipe Veloso Gomes
- Interventional Radiology Unit, Hepato-Biliary-Pancreatic and Transplant Center, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisbon, Portugal.,NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Nuno Costa
- Interventional Radiology Unit, Hepato-Biliary-Pancreatic and Transplant Center, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisbon, Portugal.,NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Tiago Bilhim
- Interventional Radiology Unit, Hepato-Biliary-Pancreatic and Transplant Center, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisbon, Portugal.,NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - José Hugo Luz
- Interventional Radiology Unit, Hepato-Biliary-Pancreatic and Transplant Center, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisbon, Portugal.,NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Élia Coimbra
- Interventional Radiology Unit, Hepato-Biliary-Pancreatic and Transplant Center, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisbon, Portugal
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