Late-onset severe biliary bleeding after endoscopic pigtail plastic stent insertion.

Muneji Yasuda,Takaaki Ito,Tomoki Sakakida,Hideki Sato,Takeshi Nishimura,Norimasa Yoshida,Yusuke Okuyama,Naoya Tomatsuri,Hiroyuki Kimura,Yoshikazu Nakatsugawa,Hideki Fujii,Shinya Yamada,Takumi Kawakami,Yuki Koyama,Hiroyuki Morishita

doi:10.3748/wjg.v23.i4.735

Muneji Yasuda, Takaaki Ito + Show 13 more

Open Access

https://doi.org/10.3748/wjg.v23.i4.735

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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.

Highlights

Biliary bleeding is an uncommon cause of upper gastrointestinal bleeding and biliary tract obstruction
We report here a case of biliary bleeding caused by long-term placement of a pigtail plastic stent, which was inserted without removal of common bile duct stones due to the patient’s age; the Transarterial embolization (TAE) treatment was successful
A patient with gastrointestinal bleeding and biliary tract obstruction due to intrabiliary rupture of hepatic arterial pseudoaneurysm, which was successfully treated by TAE and percutaneous transhepatic biliary drainage (PTBD)

Summary

Introduction

Biliary bleeding is an uncommon cause of upper gastrointestinal bleeding and biliary tract obstruction. 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. 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).

Results

Conclusion