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Bleeding causing biliary obstruction after endoscopic sphincterotomy
1Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York 10467, USA.
Insights
Recurrent biliary obstruction after endoscopic sphincterotomy can be caused by blood clots. Promptly flushing the bile duct with heparin can resolve these clots, avoiding unnecessary stone removal procedures.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Cholecystectomy and endoscopic sphincterotomy are common procedures for biliary tract issues.
- Recurrent biliary obstruction can occur post-procedure, necessitating further intervention.
Observation:
- A patient developed recurrent common bile duct obstruction following an extended endoscopic sphincterotomy.
- The obstruction was found to be caused by a blood clot within the common bile duct.
Findings:
- The blood clot was successfully removed using the Fogarty technique.
- Irrigation with heparin resolved the biliary obstruction.
- Minor hemobilia can mimic choledocholithiasis.
Implications:
- Following endoscopic sphincterotomy, flushing the bile duct should be considered before aggressive stone removal maneuvers.
- This approach may prevent complications and improve patient outcomes in managing post-sphincterotomy biliary obstruction.
Abstract:
A 68-yr-old woman who had had a cholecystectomy and endoscopic sphincterotomy developed recurrent common bile duct obstruction. She had another ERCP with extension of the site of endoscopic sphincterotomy, and 3 days later biliary obstruction again developed, this time from a blood clot filling the common bile duct. The clot was removed by Fogarty technique, and the duct was irrigated with heparin; the obstruction resolved. Minor hemobilia (biliary tract hemorrhage without overt GI bleeding) may be confused with choledocholithiasis. When biliary obstruction follows endoscopic sphincterotomy, attempts at flushing the duct should precede empiric maneuvers for stone removal.