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Recurrent Bleeding from a Hepatic Artery Pseudoaneurysm after Biliary Stent Placement
Kenji Yamauchi1, Daisuke Uchida1, Hironari Kato1
1Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan.
Internal Medicine (Tokyo, Japan)
|October 17, 2017
Summary
A rare case of hemobilia (bile duct bleeding) occurred after biliary stent placement. A hepatic artery pseudoaneurysm was identified as the cause, highlighting the need for vigilance in diagnosing rare complications.
Area of Science:
- Gastroenterology
- Interventional Radiology
- Vascular Surgery
Background:
- Benign biliary stenosis necessitates interventions like plastic stent placement to prevent obstructive cholangitis.
- Plastic stents are commonly used for biliary drainage, but complications, though rare, can occur.
Observation:
- A 78-year-old female presented with cholangitis secondary to hemobilia two weeks post-biliary plastic stent placement.
- Initial diagnostic workup including CT, ERCP, cholangioscopy, and angiography failed to identify the bleeding source.
- The source of bleeding was only identified on the seventh episode of hemobilia via CT scan, revealing a hepatic artery pseudoaneurysm.
Findings:
- A hepatic artery pseudoaneurysm was successfully treated with coil embolization.
- Hemobilia is an exceedingly rare complication following plastic biliary stent insertion.
Implications:
- Clinicians should maintain a high index of suspicion for hepatic artery pseudoaneurysm in cases of unexplained hemobilia after biliary stenting.
- Prompt diagnosis and intervention, such as coil embolization, are crucial for managing this rare but serious complication.