Abstract
BackgroundHemobilia 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 presentationA 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.ConclusionGastroduodenal 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.
Highlights
Hemobilia is a rare cause of upper gastrointestinal bleeding that originates from the biliary tract
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
Summary
Gastroduodenal artery pseudoaneurysm is a rare complication of cholecystectomy. To our knowledge, this is the fourth reported case of hemobilia due to ruptured gastroduodenal artery pseudoaneurysm after cholecystectomy. The prolonged time interval between cholecystectomy and bleeding onset (3 years), compared with other cases of postcholecystectomy hemobilia, resulted in hemobilia not being considered as the etiology of UGIB at the patient’s first presentation. This case highlights the importance of hemobilia to be considered as a possible etiology of UGIB, especially when there is a history of hepatopancreatobiliary procedure, regardless of the time interval between the invasive procedure and onset of bleeding
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