Delayed Severe Hemobilia after Endoscopic Biliary Plastic Stent Insertion

Abstract

Hemobilia is a rare gastrointestinal bleeding, usually caused by injury to the bile duct. Hemobilia after endoscopic retrograde cholangiopancreatography (ERCP) is generally self-limiting and patients will spontaneously recover, but some severe and fatal hemorrhages have been reported. ERCP-related bowel or bile duct perforation should be managed promptly, according to the type of injury and the status of the patient. We recently experienced a case of late-onset severe hemobilia in which the patient recovered after endoscopic biliary stent insertion. The problem was attributable to ERCP-related bile duct perforation during stone removal, approximately 5 weeks prior to the hemorrhagic episode. The removal of the stent was performed 10 days before the onset of hemobilia. The bleeding was successfully treated by two sessions of transarterial coil embolization.

Hemobilia due to arteriobiliary fistula complicating ERCP for residual bile duct stone in a case of Mirizzi syndrome

“…The occurrence of rectal bleeding within 48 hours of ERCP points towards this etiology. Case reports in the literature describe ERCP guide wire trauma related arteriobiliary and portobiliary fistula and plastic stent induced hemobilia 267. Once an arteriobiliary fistula develops, the patient develops immediate or delayed hemobilia as occurred in our patient 267…”

Recurrent Bleeding from a Hepatic Artery Pseudoaneurysm after Biliary Stent Placement

“…However, the exact prevalence remains uncertain. To the best of our knowledge, there have only been five previously reported cases of hemobilia caused by plastic stent placement ( 5 - 9 ). The characteristics of these five cases in addition to the case described herein are presented in Table 2 .…”

“…Several factors are associated with hemobilia after plastic stent placement. ERCP-related bile duct injury ( 6 , 9 ), malignant tumor invasion ( 5 , 8 ), cholangitis ( 7 , 8 ), and liver abscess ( 7 ) may also contribute to hemobilia. In this case, we suspect that the stent was the primary cause of the aneurysm because it developed at the same location as the stent.…”

Massive bleeding after plastic stent removal during ERCP: what’s next?

“…biliary obstruction does not resolve, portosystemic shunt surgery or transjugular intrahepatic portosystemic stent shunt is performed to decompress the portal cavernoma. Rarely, plastic stents may also induce bleeding due to rupture of the hepatic artery, which can be managed with angiography with coiling of the artery [3,4]. In general, placement of metal stents is not recommended in patients with benign diseases who are expected to have prolonged survival.…”