Hemobilia due to hepatic artery pseudoaneurysm following biliary pigtail stent placement

Hemobilia is a potentially fatal condition if not diagnosed and treated early. One of the rare causes of hemobilia is hepatic artery pseudoaneurysm. Herein, we present a case of hemobilia caused by hepatic artery pseudoaneurysm rupture. A patient with a benign stricture in the distal common bile duct who had undergone multiple endoscopic retrograde cholangiopancreatography (ERCP) procedures had a pigtail stent placed during the last ERCP. Ten days after the procedure, the patient presented to our emergency department with abdominal pain and was admitted with a diagnosis of acute pancreatitis. During follow-up, the patient underwent another ERCP due to suspected cholangitis, and severe hemobilia was observed following removal of the pigtail stent. Computed tomography (CT) angiography revealed a hepatic artery pseudoaneurysm, which was successfully treated with coil embolization. Patients with hemobilia may present with symptoms of upper gastrointestinal bleeding as well as conditions such as cholangitis and pancreatitis due to hepatic artery pseudoaneurysm rupture. Coil embolization is the first-line of interventional to stop bleeding. If this method is insufficient, surgical treatment may be considered.