A Curious Case of Coil-Angitis.

Area of Science:

• Gastroenterology
• Hepatology
• Interventional Endoscopy

Background:

• A 43-year-old male with a history of severe liver trauma and subsequent surgical repair presented with recurrent abdominal pain and obstructive jaundice.
• Complications from initial treatment included a biloma, common bile duct stenting, hemobilia, and hepatic artery pseudoaneurysm requiring embolization.

Observation:

• The patient developed obstructive transaminitis and leukocytosis, with imaging revealing a dilated common bile duct and a foreign body near the pancreatic head.
• The foreign body was identified as a migrated coil mass, a rare complication potentially related to prior endovascular procedures.

Findings:

• Urgent endoscopic retrograde cholangiopancreatography (ERCP) with cholangioscopy enabled the successful retrieval of a large (4x3 cm) coil mass from the common bile duct.
• The procedure was performed without causing further injury to the common bile duct or surrounding vascular structures.

Implications:

• This case highlights a rare but significant delayed complication of endovascular procedures following liver trauma.
• Successful endoscopic management underscores the utility of ERCP and cholangioscopy in managing complex biliary issues.
• Prompt diagnosis and intervention are crucial for preventing severe morbidity associated with migrated foreign bodies in the biliary system.