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Related Concept Videos

Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
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Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts, pancreatic ducts, and gallbladder. This procedure is beneficial for identifying and addressing blockages, gallstones, strictures, and tumors within the biliary or pancreatic systems. ERCP is both diagnostic and therapeutic, offering the ability to visualize and treat identified problems in one session.
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Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
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Related Experiment Video

Updated: Oct 13, 2025

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
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Malpositioned endoscopically inserted biliary stent causing massive hematemesis managed with vascular plug and

Mark A Reddick1, Andrew J Ceranske1, Peiman Habibollahi2

  • 1From the Division of Vascular and Interventional Radiology, Department of Radiology UT Southwestern Medical Center, Texas, USA.

Diagnostic and Interventional Radiology (Ankara, Turkey)
|November 18, 2021
PubMed
Summary
This summary is machine-generated.

A liver transplant patient experienced severe bleeding due to a misplaced stent-graft. The bleeding was successfully controlled using a vascular plug and additional stent placement, resolving the hemobilia and inferior vena cava (IVC) issue.

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Area of Science:

  • Gastroenterology and Hepatology
  • Interventional Radiology
  • Transplant Surgery

Background:

  • A 46-year-old male with a history of hepatitis B cirrhosis and hepatocellular carcinoma (HCC) underwent liver transplantation.
  • The patient experienced HCC recurrence and biliary stenosis, necessitating endoscopic biliary stent exchange.
  • One month post-procedure, the patient presented with hypovolemic shock and melena.

Observation:

  • During endoscopic retrograde cholangiopancreatography (ERCP), hemobilia was identified.
  • Uncontrollable bleeding occurred after a common bile duct (CBD) sweep, managed with a stent-graft.
  • Computed tomography angiography revealed the stent-graft was malpositioned between the major papilla and the inferior vena cava (IVC).

Findings:

  • The malpositioned stent-graft caused significant bleeding and vascular compromise.
  • Initial attempts to control bleeding via angiography were unsuccessful.
  • The bleeding was ultimately managed by deploying a vascular plug within the stent-graft and a secondary stent across the affected IVC segment.

Implications:

  • This case highlights a rare but serious complication of biliary stent-graft placement.
  • Successful management involved a multi-step interventional radiology approach.
  • Emphasizes the importance of advanced imaging and endovascular techniques in managing complex post-transplant complications.