Arteriobiliary Fistula Research Articles

Fatal hemobilia resulting from an iatrogenic arteriobiliary fistula as a rare complication of transjugular liver biopsy

Transjugular liver biopsy is an important tool for diagnosing and/or staging of advanced liver disease. This procedure is considered safe even in the presence of severe coagulopathy, although rare fatal complications have been described. We herein report the first case of fatal hemobilia after transjugular liver biopsy. A patient with alcoholic liver cirrhosis developed hematemesis 1 day after transjugular liver biopsy. Upper gastrointestinal endoscopy revealed bleeding from the papilla of Vater. Despite early intervention by angiography and embolization of an arteriobiliary fistula, the patient deteriorated and ultimately died due to multiorgan failure.

Management of a rare case of fulminant hemobilia due to arteriobiliary fistula following total pancreatectomy

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.

Sonographically Guided Percutaneous Liver Biopsy in Infants: A Retrospective Review

The purpose of our study was to assess the technical success and complication rate of sonographically guided percutaneous liver biopsies performed in infants under 1 year old at a tertiary pediatric center. Retrospective analysis of 65 biopsies performed in 61 infants between January 1999 and December 2003 was conducted. Data collected included patient demographics; details of the biopsy procedure including indication, needle type and size, number of passes, and samples; pathology results; and procedure-related complications. The 61 infants studied included 37 males and 24 females with a mean age of 119 days (age range, 7-348 days; median age, 83 days) and a mean weight of 4.5 kg (1.9-8.3 kg). A total of 65 biopsies were performed in these 61 infants. General anesthesia was used in 66.1% of procedures. An 18-gauge needle was used in 47 (72.3%) procedures. Coaxial technique was used in seven procedures, and five biopsy tracts were embolized. In 63 of 65 procedures, the mean number of passes was 1.8. In two procedures, using a coaxial technique, 11 and 12 passes were made. One biopsy was considered technically unsuccessful, and 64 of 65 (98.5%) of the biopsies provided adequate tissue for pathologic analysis. There were three (4.6%) major complications related to bleeding: one requiring a blood transfusion, one requiring surgery, and one arteriobiliary fistula requiring transarterial embolization. Three (4.6%) minor complications also occurred. There were no deaths. Sonographically guided percutaneous liver biopsy in infants is a good and effective diagnostic tool. The complication rate, however, even when performed by an experienced physician, is not insignificant in this age group of patients.

Hemobilia Due to Hepatic Artery Pseudoaneurysm˙ An Unusual Complication after Cholecystectomy and T-Tube Placement

Hemobilia is one of the causes of obscure gastrointestinal hemorrhage. Arterio-biliary fistula secondary to hepatic artery pseudoaneurysm is an uncommon cause of hemobilia. Hepatic artery pseudoaneurysm has been reported as a rare complication of laparoscopic cholecystectomy. We here report a case of hemobilia due to arterio-biliary fistula in a patient one month after cholecystecomy and percutaneous T-tube placement. A 54 year old woman underwent laparoscopic cholecystectomy for symptomatic cholelithiasis. During the procedure, there was a concern of injury to the common hepatic duct due to difficult gall bladder dissection. Laparoscopic cholecystectomy was converted to an open cholecystectomy which did show common hepatic duct laceration which was repaired and a T-tube was placed. Patient did well for a month after the surgery, when she developed right upper quadrant abdominal pain, jaundice and noted to have migrated out T-tube. Subsequently, T-tube was removed due to malfunction. A computed tomography scan of the abdomen showed dilation of the intra and extra hepatic biliary ducts. Patient underwent endoscopic retrograde cholangiography (ERC) and found to have gross hemobilia. ERC images showed dilated common bile duct with multiple cast-like filling defects, consistent with blood clots. A biliary stent was placed to maintain biliary drainage. Patient continued to require blood transfusions due to ongoing hemobilia. A selective hepatic arteriogram showed hepatic artery pseudo-aneurysm causing arterio-biliary fistula leading to hemobilia. A covered stent was placed in the right hepatic artery occluding the fistula, which resulted in complete resolution of bleeding.

Coil Embolization of an Arteriobiliary Fistula Caused by Hepatic Intra-Arterial Chemotherapy

Arteriobiliary fistula is a rare complication of hepatic intra-arterial chemotherapy. We report successful coil embolization of an arteriobiliary fistula. An 80-year-old woman underwent percutaneous placement of an indwelling catheter into the replaced right hepatic artery for intra-arterial chemotherapy of liver metastases. Coil embolization of the left hepatic artery was not performed. The patient complained of abdominal pain during intra-arterial chemotherapy. Angiography revealed a fistula between the replaced right hepatic artery and the common bile duct. The fistula was successfully treated by coil embolization via the indwelling catheter, and the indwelling catheter was removed. Although such complications usually herald the termination of intra-arterial chemotherapy, the patient underwent percutaneous implantation of a new catheter-port system, and intra-arterial chemotherapy was restarted.

Nonoperative Management of Iatrogenic Lesions of Celiac Branches by Using Transcatheter Arterial Embolization

We present our experience in the nonoperative management of iatrogenic lesions of celiac branches by using transcatheter arterial embolization. We treated 6 pseudoaneurysms (5 intrahepatic and 1 of the gastroduodenal artery), 6 vessel lacerations (1 common hepatic artery, 1 right hepatic artery, 1 gastroduodenal artery, 2 pancreatoduodenal, 1 polar intrasplenic artery), 1 arterioportal fistula, and 1 arteriobiliary fistula; all the bleeding lesions were secondary to surgical, endoscopic, or interventional radiologic procedures.

Influence of operator experience on performance of ultrasound-guided percutaneous liver biopsy.

The purpose was to evaluate the influence of radiologist's experience on the diagnostic yield and complications of a percutaneous liver biopsy (PLB) method. Six hundred patients underwent an ultrasound-guided PLB by an inexperienced operator in 25.2% of cases (experience of less than 15 percutaneous liver biopsies performed alone--group I) or by an experienced operator (experience of more than 150 percutaneous liver biopsies--group II). The two groups were well-matched with respect to sex, age, percentage with viral hepatitis without histological cirrhosis, number of needle passes, history of liver biopsy and pain before the biopsy. A histological diagnosis was available in 97.3% of cases without any significant difference between the two groups ( P=0.25). However, group II samples were significantly longer and contained more portal tracts ( P=0.01). Pain was mild immediately and 6 h after the biopsy, without significant difference between both groups. Eight vasovagal reactions (five in group II) and one arteriobiliary fistula (in group II) occurred. With the method of PLB used for this study, operator's experience did not influence either the final histological diagnosis or the degree of pain suffered.

An unusual case of haemobilia

Arterio-biliary fistula is an uncommon cause of haemobilia. We describe a case of right hepatic artery pseudo-aneurysm causing arterio-biliary fistula and presenting as severe melaena and cholangitis. Gastroduodenoscopy failed to establish the exact source of bleeding and hepatic artery angiography and selective embolization of the pseudo-aneurysm successfully controlled the bleeding. Pseudo-aneurysm of the hepatic artery is mostly iatrogenic due to biliary intervention, as demonstrated in this case. Difficulty in diagnosis and management is discussed together with a review of the literature.

Videolaparoscopic Management of Percutaneous Liver Biopsy Complications

Percutaneous liver biopsy is a routine procedure in the diagnosis, management, and follow-up of several liver disorders. Mortality and morbidity rates from percutaneous liver biopsy are low. This report of three cases of serious percutaneous liver biopsy complication and their management highlights the role played by videolaparoscopy as a diagnostic and therapeutic procedure in two different types of PLB complication: hemobilia and bile peritonitis. In two patients, intrahepatic arteriobiliary fistula developed with gastrointestinal hemorrhage (hemobilia). Both were treated with cholecystectomy and ligation of the right branch of the hepatic artery. In the third case, the percutaneous liver biopsy needle punctured the gallbladder, leading to bile peritonitis and acute abdomen, and the patient underwent videolaparoscopic cholecystectomy with aspiration and lavage of the abdominal cavity. Videolaparoscopic procedures are an adequate alternative for the management of serious percutaneous liver biopsy complications such as hemobilia and bile peritonitis. The advantages of a videolaparoscopy include low morbidity rates, quick recovery, good cosmetic result, and ability to resolve the complications of percutaneous liver biopsy.

Arteriography in hepatic trauma.

The arteriographic findings associated with hepatic trauma were studied in 87 patients. Arterial occlusion, marked extravasation, slight hemorrhage, pseudo-tumor, subcapsular hematoma, arteriobiliary fistula, and arterioportal fistula were seen either in isolation or randomly grouped. Differentiation of these lesions is discussed. Apparent disagreements between the anatomical appearances and the radiographic images at times arise, and a complete knowledge of arterial anatomy is necessary to avoid underestimation of the size or nature of the lesion.

Selective hepatic arteriography in the management of traumatic hemobilia

Traumatic hemobilia is a rare condition which still carries a high mortality with or without surgery. Accurate early diagnosis is seldom achieved and recurrence after attempted surgical control is all too common. For these reasons, most patients undergo multiple operations before death or cure, and there is as yet no surgical consensus concerning proper management of these cases. Selective hepatic arteriography in two children with this condition revealed a cavitary lesion of the left lobe in one, and an arterio-biliary fistula in the right lobe of the other. Recovery followed left hepatic lobectomy in the first and selective ligation of an aberrant right hepatic artery in the other. Selective hepatic arteriography is the key to adequate surgical treatment.