Arteriocholedochal fistula: an unusual cause of hemobilia

Abstract

We report an unusual cause of hemobilia in a patient with a transhepatic biliary catheter. Hemobilia was due to an extrahepatic fistula between the gastroduodenal artery and the common bile duct and was responsible for significant blood loss. The fistula was successfully treated with transarterial embolization that resulted in no further episodes of hemobilia during the following 12 months.

Haemobilia

“…Cholangiography is useful if there is already percutaneous access or if endoscopic retrograde cholangiopancreatography (ERCP) is performed 28,175 . Blood may be seen re¯uxing down drainage catheters or at the papilla of Vater, and contrast studies may show ®lling defects in the biliary tree.…”

“…The morphology of these defects is variable. String-like defects may occur if the clots have formed a cast of the biliary tree 28 , or smaller spherical defects may be seen 118 (it is of particular importance to discriminate these from gallstones 89,138 ). Aneurysm or pseudoaneurysm of the hepatic artery may cause indentation of the bile duct, and biloma may be noted 179 .…”

Spontaneous Arteriocholedochal Fistula as a Cause of Life-Threatening Hemobilia in a Type I Giant Choledochal Cyst: A Case Report on an Unusual Situation Requiring Whipple’s Pancreatoduodenectomy

“…However, it is not necessary that all three symptoms be present [8]. If the flow of blood into the duodenum through the biliary tract is blocked by blood clots, gastrointestinal bleeding may not occur, especially, if bleeding is not brisk [4,5,8]. Our patient also did not have GI bleeding as a clinical finding, possibly because of a blood clot at the outflow.…”

“…Arteriocholedochal fistulas are unusual findings that have been commonly reported as an iatrogenic complication [4]. Giant choledochal cysts are also rare findings as choledochal cysts rarely exceed 9 cm in size [12].…”

“…Life-threatening hemobilia is a rare cause of gastrointestinal bleeding with arteriocholedochal fistula being an unusual cause of hemobilia [1-4]. Arteriocholedochal fistulas have been reported after invasive procedures such as percutaneous transhepatic cholangiography, percutaneous biliary stent procedures, transhepatic biopsies; after trauma and surgery to the hepatobiliary tract; and even after liver transplant [1,2,4-7]. They are treated efficiently by angioembolization of the involved vessel leading to complete resolution in 80-100% cases [2,5,8].…”