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Two cases of biliary hemorrhage after percutaneous transhepatic biliary drainage in which transcatheter arterial
H Kinoshita1, H Imayama, M Hashimoto
1Department of Surgery, Kurume University School of Medicine, Japan.
Insights
Biliary hemorrhage after percutaneous transhepatic biliary or gallbladder drainage (PTBD/PTGBD) can indicate a false aneurysm. Prompt diagnosis and transcatheter arterial embolization (TAE) are crucial for managing this complication.
Area of Science:
- Interventional Radiology
- Gastroenterology
- Vascular Surgery
Background:
- Percutaneous transhepatic biliary drainage (PTBD) and percutaneous transhepatic gallbladder drainage (PTGBD) are procedures used to manage biliary obstruction.
- Complications such as biliary hemorrhage can arise following these interventions.
Observation:
- Two patients experienced biliary hemorrhage after PTBD/PTGBD, with one case occurring post-surgery.
- Hemorrhage was initially transient but recurred, leading to shock in both cases.
- Angiography revealed false aneurysms in the hepatic artery branches (A6 and A3).
Findings:
- Transcatheter arterial embolization (TAE) using microcoils successfully stopped the hemorrhage in both patients.
- One patient underwent pancreatoduodenectomy prior to TAE, while the other had cholangioscopic lithectomy post-TAE.
- False aneurysms are a critical consideration in the differential diagnosis of biliary hemorrhage post-PT(G)BD.
Implications:
- This highlights the importance of considering false aneurysm formation in patients presenting with biliary hemorrhage after PTBD/PTGBD.
- Timely diagnosis via angiography and endovascular management with TAE can be life-saving.
- Further research into risk factors and preventative strategies for post-PT(G)BD false aneurysms is warranted.
Abstract:
Patient No. 1 was a 66-year-old male who was diagnosed as having cancer of the caput pancreatis, and underwent percutaneous transhepatic biliary drainage (PTBD). Since the tube slipped out, percutaneous transhepatic gallbladder drainage (PTGBD) was performed. After PTGBD, biliary hemorrhage was observed for two to three days, then hemorrhage disappeared and bile flowed smoothly. Since the tube was likely to slip out, the tube was replaced. After replacement of the tube, biliary hemorrhage was noted for two to three days, then spontaneously subsided again. After icterus was reduced, pancreatoduodenectomy was performed. During surgery, a number of massive blood clots were noted in the bile duct. The PTGBD tube was removed, and a transjejunal tube was placed. On the 11th day after the surgery, hemorrhage occurred in the bile duct tube, and the patient went into shock. Emergency abdominal angiography was performed. A false aneurysm was detected in A6 and embolized using a microcoil. After transcatheter arterial embolization (TAE), hemorrhage stopped, and the patient was discharged. Patient No. 2 was a 68-year-old male who was diagnosed as having cholelithiasis and underwent PTBD. On the 21st day after PTBD, biliary hemorrhage occurred and the patient fell in shock status. Emergency abdominal angiography was performed. A false aneurysm was detected in A3 and embolized using a microcoil. After TAE, cholangioscopic lithectomy was performed and the disease alleviated. Thereafter the patient was discharged. It is necessary to consider false aneurysm when biliary hemorrhage occurs after PT(G)BD.