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Motohara T, Yamamura K, Ueno S, Takeno H, Nagayama Y, Oda E, Karashima R, Ozaki N, Masuda T, Beppu T. A rare incidence of a hepatic artery pseudoaneurysm following plastic biliary stent insertion. Clin J Gastroenterol 2024; 17:352-355. [PMID: 38363445 DOI: 10.1007/s12328-024-01920-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/03/2024] [Indexed: 02/17/2024]
Abstract
Hepatic artery pseudoaneurysms have been reported to occur in approximately 1% of cases after metal stenting for malignant biliary obstruction. In contrast, only a few cases have been reported as complications after plastic stenting for benign biliary disease. We report a 61-year-old man with cholangitis who presented with a rare complication of hemobilia after implantation of 7 Fr double pigtail plastic biliary stents. No bleeding was observed approximately one month after biliary stent tube removal. Contrast-enhanced CT scan revealed a circularly enhanced lesion (5 mm in diameter) in the arterial phase at the tip of the previously inserted plastic bile duct stent. Color Doppler ultrasonography enhanced the lesion and detected arterial blood flow inside. He was diagnosed with a hepatic artery pseudoaneurysm. However, he had no risk factors such as prolonged catheterization, severe cholangitis, liver abscess, or long-term steroid use. Superselective transarterial embolization using two metal microcoils was successfully completed without damage to the surrounding liver parenchyma. If hemobilia is suspected after insertion of a plastic bile duct stent, immediate monitoring using contrast-enhanced computed tomography or Doppler ultrasonography is recommended.
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Affiliation(s)
- Toshihiko Motohara
- Department of Gastroenterology, Yamaga City Medical Center, yamaga, Japan
| | - Kensuke Yamamura
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
| | - Shigenori Ueno
- Department of Gastroenterology, Yamaga City Medical Center, yamaga, Japan
| | - Hiroshi Takeno
- Department of Gastroenterology, Yamaga City Medical Center, yamaga, Japan
| | - Yasunori Nagayama
- Department of Diagnostic Radiology, Graduate School of Life Science, Kumamoto University, Kumamoto, Japan
| | - Eri Oda
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
| | | | - Nobuyuki Ozaki
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
| | - Toshiro Masuda
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
| | - Toru Beppu
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan.
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Kim PH, Kim JW, Gwon DI, Ko GY, Shin JH, Yoon HK. Embolization for delayed arterial bleeding after percutaneous self-expandable metallic stent placement in patients with malignant biliary obstruction. Br J Radiol 2019; 93:20190637. [PMID: 31778313 DOI: 10.1259/bjr.20190637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To retrospectively evaluate the safety and efficacy of transcatheter arterial embolization (TAE) for delayed arterial bleeding secondary to percutaneous self-expandable metallic stent (SEMS) placement in patients with malignant biliary obstruction (MBO). METHODS From January 1997 to September 2017, 1858 patients underwent percutaneous SEMS placement for MBO at a single tertiary referral center. Among them, 19 patients (mean age, 70.2 [range, 52-82] years; 13 men) presented with delayed SEMS-associated arterial bleeding and underwent TAE. RESULTS The incidence of delayed arterial bleeding was 1.0% (19/1858) after SEMS placement, with a median time interval of 225 days (range, 22-2296). Digital subtraction angiography (DSA) showed pseudoaneurysm alone close to the stent mesh (n = 10), pseudoaneurysm close to the stent mesh with contrast extravasation to the duodenum (n = 3), pseudoaneurysm close to the stent mesh with arteriobiliary fistula (n = 1), in-stent pseudoaneurysm alone (n = 4) and in-stent pseudoaneurysm with arteriobiliary fistula (n = 1). Bleeding was stopped after the embolization in all patients. Overall clinical success rate was 94.7% (18/19). One patient with recurrent bleeding was successfully treated with a second embolization. Overall 30-day mortality rate was 26.3% (5/19). A major procedure-related complication was acute hepatic failure in one hilar bile duct cancer patient (5.3%), which was associated with an obliterated portal vein. CONCLUSION TAE is safe and effective for the treatment of delayed arterial bleeding after percutaneous SEMS placement for MBO. ADVANCES IN KNOWLEDGE This study demonstrated TAE is safe and effective for arterial bleeding after SEMS placement after MBO through the largest case series so far.
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Affiliation(s)
- Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
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Miyamoto H, Tanaka K, Nakamura F, Ikeda T, Kitamura S, Kimura T, Okamoto K, Sogabe M, Muguruma N, Bando Y, Takayama T. Massive hemobilia following plastic stent removal in common bile duct cancer associated with primary sclerosing cholangitis (with video). Clin J Gastroenterol 2018; 12:46-51. [PMID: 30056613 DOI: 10.1007/s12328-018-0888-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 07/24/2018] [Indexed: 11/11/2022]
Abstract
Hemobilia is defined as bleeding into the biliary tract. Herein, we report a very rare case of massive hemobilia following plastic stent (PS) removal in common bile duct (CBD) cancer. A 72-year-old man with primary sclerosing cholangitis had undergone repeated insertion of a PS into the CBD. Biliary tract biopsy was performed based on suspicion of combined CBD cancer. Biopsy revealed poorly differentiated adenocarcinoma of the CBD. One month after the biliary tract biopsy, he was admitted for acute cholangitis, and endoscopic retrograde cholangiography was performed for the exchange of the PS. When one of the two biliary PSs was removed, spurting bleeding from the major papilla began abruptly. The massive bleeding caused the patient to be in a pre-shock state. A retrieval balloon catheter was compressed against the papilla for hemostasis. Although he was treated conservatively, the patient developed a bloody discharge. Upper gastrointestinal endoscopy revealed that the pulsatile bleeding beside the PSs started immediately after the removal of the coagula. Emergent contrast-enhanced computed tomography showed right hepatic artery aneurysm across the CBD. Therefore, transarterial embolization was performed. The patient's post-therapeutic course was uneventful. He received chemotherapy, but died about a half year after hemobilia occurred.
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Affiliation(s)
- Hiroshi Miyamoto
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan.
| | - Kumiko Tanaka
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Fumika Nakamura
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Takahiro Ikeda
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Shinji Kitamura
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Tetsuo Kimura
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Koichi Okamoto
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Masahiro Sogabe
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Naoki Muguruma
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Yoshimi Bando
- Department of Pathology, Tokushima University Hospital, Tokushima, Japan
| | - Tetsuji Takayama
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan.
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Abstract
A 78-year-old woman was admitted with benign biliary stenosis. A plastic stent was placed at the left branch to prevent obstructive cholangitis. Two weeks after the procedure, the patient was readmitted with cholangitis caused by hemobilia. However, computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), peroral cholangioscopy, and abdominal angiography failed to establish the bleeding source. At the seventh bleeding, CT revealed a hepatic artery pseudoaneurysm for which coil embolization was successfully performed. Hemobilia after plastic stent placement is extremely rare. We urge clinicians to consider the possibility of a pseudoaneurysm near the stent when trying to identify the bleeding source.
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Affiliation(s)
- Kenji Yamauchi
- Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Daisuke Uchida
- Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Hironari Kato
- Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Hiroyuki Okada
- Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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Cathcart S, Birk JW, Tadros M, Schuster M. Hemobilia: An Uncommon But Notable Cause of Upper Gastrointestinal Bleeding. J Clin Gastroenterol 2017. [PMID: 28644311 DOI: 10.1097/mcg.0000000000000876] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
GOAL AND BACKGROUND A literature review to improve practitioners' knowledge and performance concerning the epidemiology, diagnosis, and management of hemobilia. STUDY A search of Pubmed, Google Scholar, and Medline was conducted using the keyword hemobilia and relevant articles were reviewed and analyzed. The findings pertaining to hemobilia etiology, investigation, and management techniques were considered and organized by clinicians practiced in hemobilia. RESULTS The majority of current hemobilia cases have an iatrogenic cause from either bile duct or liver manipulation. Blunt trauma is also a significant cause of hemobilia. The classic triad presentation of right upper quadrant pain, jaundice, and upper gastrointestinal bleeding is rarely seen. Computed tomography and magnetic resonance imaging are the preferred diagnostic modalities, and the preferred therapeutic management includes interventional radiology and endoscopic retrograde cholangiopancreatography. Surgery is rarely a therapeutic option. CONCLUSIONS With advances in computed tomography and magnetic resonance imaging technology, diagnosis with these less invasive investigations are the favored option. However, traditional catheter angiography is still the gold standard. The management of significant hemobilia is still centered on arterial embolization, but arterial and biliary stents have become accepted alternative therapies.
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Affiliation(s)
- Scott Cathcart
- *Albany Medical Center, Albany Medical College Departments of §Radiology ‡Gastroenterology & Hepatology, Albany Medical Center, Albany, NY †Division of Gastroenterology & Hepatology, Gastroenterology & Hepatology Fellowship Program, UConn School of Medicine, Farmington, CT
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Kim HJ. Pancreaticoduodenal artery pseudoaneurysm-induced hemobilia caused by a plastic biliary stent. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2017. [DOI: 10.18528/gii170007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hong Joo Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Yasuda M, Sato H, Koyama Y, Sakakida T, Kawakami T, Nishimura T, Fujii H, Nakatsugawa Y, Yamada S, Tomatsuri N, Okuyama Y, Kimura H, Ito T, Morishita H, Yoshida N. Late-onset severe biliary bleeding after endoscopic pigtail plastic stent insertion. World J Gastroenterol 2017; 23:735-739. [PMID: 28216982 PMCID: PMC5292349 DOI: 10.3748/wjg.v23.i4.735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/09/2016] [Accepted: 11/28/2016] [Indexed: 02/06/2023] Open
Abstract
Here, we report our experience with a case of severe biliary bleeding due to a hepatic arterial pseudoaneurysm that had developed 1 year after endoscopic biliary plastic stent insertion. The patient, a 78-year-old woman, presented with hematemesis and obstructive jaundice. Ruptured hepatic arterial pseudoaneurysm was diagnosed, which was suspected to have been caused by long-term placement of an endoscopic retrograde biliary drainage (ERBD) stent. This episode of biliary bleeding was successfully treated by transarterial embolization (TAE). Pseudoaneurysm leading to hemobilia is a rare but potentially fatal complication in patients with long-term placement of ERBD. TAE is a minimally invasive procedure that offers effective treatment for biliary bleeding.
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Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, Bruining DH, Eloubeidi MA, Fanelli RD, Faulx AL, Gurudu SR, Kothari S, Lightdale JR, Qumseya BJ, Shaukat A, Wang A, Wani SB, Yang J, DeWitt JM. Adverse events associated with ERCP. Gastrointest Endosc 2017; 85:32-47. [PMID: 27546389 DOI: 10.1016/j.gie.2016.06.051] [Citation(s) in RCA: 438] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 02/07/2023]
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Intrahepatic Artery Pseudoaneurysm-induced Hemobilia Caused by a Plastic Biliary Stent After ABO-incompatible Living-donor Liver Transplantation: A Case Report. Transplant Proc 2016; 48:3178-3180. [PMID: 27932176 DOI: 10.1016/j.transproceed.2016.02.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 12/20/2022]
Abstract
Bile leakage after duct-to-duct anastomosis in living-donor liver transplantation (LDLT) can mostly be managed by therapeutic endoscopic retrograde cholangiopancreatography. Following this, various complications such as biliary infection, pancreatitis, perforation, and bleeding can occur, and endoscopic sphincterotomy is primarily associated with post- endoscopic retrograde cholangiopancreatography bleeding; other causes have been published in case reports. In the present case, a plastic biliary stent used for treating liver abscesses and leakage at the bile duct anastomosis site after ABO-incompatible LDLT resulted in an intrahepatic artery pseudoaneurysm and hemobilia, which were managed by angiography and coil embolization. Although the complex postoperative course after LDLT can obscure the prompt diagnosis of an intrahepatic artery pseudoaneurysm and hemobilia, biliary stenting should be considered as a possible cause.
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Lee SH, Hong SG, Lee KY, Park PK, Kim SD, Lee M, Yu DW, Hong MY. Delayed Severe Hemobilia after Endoscopic Biliary Plastic Stent Insertion. Clin Endosc 2016; 49:303-7. [PMID: 27012288 PMCID: PMC4895946 DOI: 10.5946/ce.2015.081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 02/10/2016] [Accepted: 02/12/2016] [Indexed: 02/05/2023] Open
Abstract
Hemobilia is a rare gastrointestinal bleeding, usually caused by injury to the bile duct. Hemobilia after endoscopic retrograde cholangiopancreatography (ERCP) is generally self-limiting and patients will spontaneously recover, but some severe and fatal hemorrhages have been reported. ERCP-related bowel or bile duct perforation should be managed promptly, according to the type of injury and the status of the patient. We recently experienced a case of late-onset severe hemobilia in which the patient recovered after endoscopic biliary stent insertion. The problem was attributable to ERCP-related bile duct perforation during stone removal, approximately 5 weeks prior to the hemorrhagic episode. The removal of the stent was performed 10 days before the onset of hemobilia. The bleeding was successfully treated by two sessions of transarterial coil embolization.
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Affiliation(s)
| | - Seung Goun Hong
- Correspondence: Seung Goun Hong, Department of Internal Medicine, SAM Anyang Hospital, 9 Samdeok-ro, Manan-gu, Anyang 14030, Korea Tel: +82-31-467-9114, Fax: +82-31-449-0151, E-mail:
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Hyun D, Park KB, Hwang JC, Shin BS. Delayed, life-threatening hemorrhage after self-expandable metallic biliary stent placement: clinical manifestations and endovascular treatment. Acta Radiol 2013; 54:939-43. [PMID: 23761546 DOI: 10.1177/0284185113485501] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Life-threatening, delayed hemorrhage after self-expandable metallic stent (SEMS) insertion for malignant biliary obstruction is very rare. Clinical manifestations, radiologic characteristics, treatment, and prognosis of this complication are not well-known. PURPOSE To present the clinical manifestations, radiologic findings, and endovascular treatment of life-threatening, delayed hemorrhage secondary to SEMS placement. MATERIAL AND METHODS A total of six patients (five men and one woman; mean age, 65.5 years) with life-threatening, delayed arterial bleeding after SEMS placement for malignant bile duct obstruction were recruited between 2000 and 2011 from three different hospitals in Korea. The original SEMS placement in all patients utilized either percutaneous (n = 3) or endoscopic approaches (n = 3). We retrospectively reviewed the clinical presentations, computed tomography (CT) and angiographic findings, endovascular treatments, and prognoses of these patients. RESULTS All patients presented with life-threatening gastrointestinal bleeding such as melena (n = 4), hematochezia (n = 1), and hematemesis (n = 1). Mean time period between biliary metallic stent insertion and presentation with bleeding was 75 days (range, 15-152 days). All stents were encased by primary or metastatic cancer along with nearby arteries on CT images. Digital subtraction angiogram (DSA) revealed pseudoaneurysm close to the stent (n = 2), in-stent pseudoaneurysm (n = 2), arteriobiliary fistula (n = 1), or pseudoaneurysm with arteriobiliary fistula (n = 1). The origins of hemorrhage were the gastroduodenal artery (n = 3), the aberrant right posterior hepatic artery from the gastroduodenal artery (n = 2), and the right hepatic artery (n = 1). Hemorrhages were successfully controlled after intra-arterial coil embolization in five patients followed by placement of a stent graft and direct puncture N-butyl-2-cyanoacrylate (NBCA) embolization in one patient. CONCLUSION Life-threatening, delayed hemorrhage within a metallic biliary stent may occur if a stent is placed across the bulky bile duct tumor or tumor encases the stent. Bleeding can be successfully treated with endovascular treatment. However, the overall prognosis was poor.
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Affiliation(s)
- Dongho Hyun
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Kwang Bo Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Jae Cheol Hwang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan
| | - Byung Seok Shin
- Department of Radiology, Chung Nam National University Hospital, Chung Nam National University College of Medicine, Daejeon, Korea
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Yang JCT, Chang CC, Shih IL. An unusual complication of percutaneous biliary stenting. Gastroenterology 2012; 142:e11-2. [PMID: 22449584 DOI: 10.1053/j.gastro.2011.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 11/01/2011] [Indexed: 12/02/2022]
Affiliation(s)
- Justin Cheng-Ta Yang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Welsch T, Hallscheidt P, Schmidt J, Steinhardt HJ, Büchler MW, Sido B. Management of a rare case of fulminant hemobilia due to arteriobiliary fistula following total pancreatectomy. J Gastroenterol 2006; 41:1116-9. [PMID: 17160523 DOI: 10.1007/s00535-006-1905-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Accepted: 09/01/2006] [Indexed: 02/04/2023]
Abstract
Hemobilia is a rare cause of acute upper gastrointestinal bleeding and is often associated with a history of hepatic or biliary tract injury, tumor growth, hepatic artery aneurysm, cholecystitis, or hepatic abscess. We report a case of a 76-year-old patient with massive hemobilia due to intrahepatic bleeding from the segment 8 hepatic artery without evidence of a true aneurysm, abscess, or metastatic disease 4 weeks following pylorus-preserving total pancreatectomy for pancreatic cancer. Gastroduodenoscopy suggested hemorrhage from the duodenojejunostomy but failed to achieve hemostasis, and the patient underwent exploratory laparotomy. It was realized intraoperatively that the bleeding originated from the intrahepatic biliary tract. Bleeding was controlled by blocking the right hepatic bile duct with a Fogarty catheter and subsequent transarterial embolization. Computed tomography did not reveal any local liver or vascular pathology. Retrospectively, the cause of delayed profuse hemobilia was most likely a traumatic intrahepatic pseudoaneurysm following endoscopic bile duct stenting 3 weeks before the pancreatectomy. The reported case is exceptional and of particular interest because of the absence of a typical history or cause of hemobilia, preoperative misleading diagnostic results in an altered anatomic situation, and the operative management to achieve bleeding control in this emergency setting.
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Affiliation(s)
- Thilo Welsch
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg 69120, Germany
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Affiliation(s)
- Gilles Lesur
- Fédération des Spécialités Digestives, Hôpital Ambroise Paré, 92104 Boulogne Cedex, France.
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