Recurrent Bleeding from a Hepatic Artery Pseudoaneurysm after Biliary Stent Placement

A 78-year-old woman was admitted with benign biliary stenosis. A plastic stent was placed at the left branch to prevent obstructive cholangitis. Two weeks after the procedure, the patient was readmitted with cholangitis caused by hemobilia. However, computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), peroral cholangioscopy, and abdominal angiography failed to establish the bleeding source. At the seventh bleeding, CT revealed a hepatic artery pseudoaneurysm for which coil embolization was successfully performed. Hemobilia after plastic stent placement is extremely rare. We urge clinicians to consider the possibility of a pseudoaneurysm near the stent when trying to identify the bleeding source.