Dark green urine following endoscopic ultrasound-guided hepaticogastrostomy: A case report

Endoscopic ultrasound-guided biliary drainage, including endoscopic ultrasound-guided choledochoduodenostomy and endoscopic ultrasound-guided hepatogastrostomy (EUS-HGS), is an efficacious alternative to endoscopic retrograde cholangiopancreatography and its common complications are bile leak, infection, stent migration and bleeding. Here, we report an atypical case of a patient who developed unexplained dark green urine after receiving EUS-HGS, which we suspected to be caused by an abnormal biliary-vascular fistula.

A 76-year-old woman diagnosed with pancreatic adenocarcinoma received EUS-HGS for relieving jaundice. The patient reported abdominal pain and chest tightness after the operation, with difficulty in urinating. X-ray suggested right-sided pleural effusion and dark green pleural effusion was drained out. However, the patient also developed dark green urine, which appeared everyday afternoon and disappeared automatically after intravenous treatment. The previous pleural effusion disappeared after one week, but later the patient showed an increase of ascites, and the lesions were compartmentalized and encapsulated internally.

Postoperative surveillance after EUS-HGS must be emphasized to check for in order to prevent severe and hidden complications.