Hemobilia after bile duct resection: perforation of pseudoaneurysm into intra-pancreatic remnant bile duct: a case repor
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CASE REPORT
Hemobilia after bile duct resection: perforation of pseudoaneurysm into intra‑pancreatic remnant bile duct: a case report Kazuhiro Yoshida1, Yuzo Umeda1*, Masaya Iwamuro2, Kazuyuki Matsumoto2, Hironari Kato2, Mayu Uka3, Yusuke Matsui3, Ryuichi Yoshida1, Takashi Kuise1, Kazuya Yasui1, Kosei Takagi1, Hiroyuki Araki1, Takahito Yagi1 and Toshiyoshi Fujiwara1
Abstract Background: Hemobilia occurs mainly due to iatrogenic factors such as impairment of the right hepatic or cystic artery, and/or common bile duct in hepatobiliary-pancreatic surgery. However, little or no cases with hemobilia from the intra-pancreatic remnant bile duct after bile duct resection (BDR) has been reported. Here, we report a case of massive hemobilia due to the perforation of psuedoaneurysm of the gastroduodenal artery (GDA) to the intra-pancreatic remnant bile duct after hepatectomy with BDR. Case presentation: A 68-year-old male underwent extended right hepatectomy with BDR for gallbladder carcinoma. He presented with upper gastrointestinal bleeding 2 months after the initial surgery. Upper endoscopy identified a blood clot from the ampulla of Vater and simultaneous endoscopic balloon tamponade contributed to temporary hemostasis. Abdominal CT and angiography revealed a perforation of the psuedoaneurysm of the GDA to the intra-pancreatic remnant bile duct resulting in massive hemobilia. Subsequent selective embolization of the pseudoaneurysm with micro-coils could achieve complete hemostasis. He survived without any recurrence of cancer and bleeding. Conclusion: Hemobilia could occur in a patient with BDR due to perforation of the pseudoaneurysm derived from the GDA to the intra-pancreatic remnant bile duct. Endoscopic balloon tamponade was useful for a temporal hemostasis and a subsequent radiologic interventional approach. Keywords: Hemobilia, Bile duct resection, Hepatectomy, Endoscopic balloon tamponade, Case report
*Correspondence: [email protected] 1 Department of Gastroenterological Surgery and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata‑cho 2‑5‑1, Kita‑ku, Okayama city, Okayama 7000914, Japan Full list of author information is available at the end of the article
Background Hemobilia is defined as the extravasation of blood into the biliary tract. It is one of the morbidities related to hepato-biliary-pancreatic surgery, and ranges from minor to severe bleeding, which is life-threatening [1, 2]. The main cause of hemobilia is iatrogenic, such as impairment of the right hepatic or cystic artery, and bile duct [2]. A pseudoaneurysm of the gastroduodenal artery (GDA) is known to cause hemobilia due to common bile duct perforation [3]. However, there has been
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