Life-threatening hemobilia caused by hepatic artery pseudoaneurysm: A rare complication of chronic cholangitis

Abstract

Hemobilia is one of the causes of obscure gastrointestinal haemorrhage. Most cases of hemobilia are of iatrogenic or traumatic origin. Hemobilia caused by a hepatic artery pseudoaneurysm due to ascending cholangitis is very rare and its mechanism is unclear. We report a 74-year-old woman with a history of surgery for choledocholithiasis 30 years ago, suffering from a protracted course of life-threatening gastrointestinal bleeding. A small intestines series and endoscopic retrograde cholangiopancreatography revealed a chronic cholangitis with marked contrast reflux into the biliary tree. Angiography confirmed the bleeding from a pseudoaneurysm of the middle hepatic artery. Coil embolization achieved successful hemostasis. We discussed the mechanism and reviewed the literature.Liu TT, Hou MC, Lin HC, Chang FY, Lee SD. Life-threatening hemobilia caused by hepatic artery pseudoaneurysm: A rare complication of chronic cholangitis. World J Gastroenterol 2003; 9(12): 2883-2884

Hemobilia Due to Cystic Artery Stump Pseudoaneurysm Following Laparoscopic Cholecystectomy: Case Presentation and Literature Review

“…Because of its high diagnostic accuracy and therapeutic potential, angiography is considered a useful modality in the diagnosis and management of hemobilia. 16,17 The reported success rate of angiographic control of hemobilia by transarterial embolization is 80% to 100%. 16,17 However, its diagnostic limitations have been noted to include variable flow rate and intermittent bleeding, as well as hepatic artery abnormalities.…”

Hemobilia due to pseudoaneurysm of the cystic artery

“…Nevertheless, angiography has certain diagnostic limitations for the variable flow rate and intermittent bleeding, and also when there are hepatic artery abnormalities or has been previous manipulation [1]. Moreover, although the reported success rate of angiographic control of hemobilia by transarterial embolization is 80 to 100% [5], this entails some serious risks such as hepatobiliary necrosis, bleeding, abscess formation and gallbladder fibrosis [1]. As a result, some authors argue that the treatment of choice for hemobilia should be surgery whenever cholecystitis, gallstones or resectable neoplasms are present or if embolization fails [1,2,5].…”

“…Moreover, although the reported success rate of angiographic control of hemobilia by transarterial embolization is 80 to 100% [5], this entails some serious risks such as hepatobiliary necrosis, bleeding, abscess formation and gallbladder fibrosis [1]. As a result, some authors argue that the treatment of choice for hemobilia should be surgery whenever cholecystitis, gallstones or resectable neoplasms are present or if embolization fails [1,2,5]. Generally, hemobilia should be managed by a combined approach, regardless of the cause: embolization of the bleeding vessel to stabilize the patient followed by cholecystectomy at a later, safer time [3,4,6], which should be better even though two invasive procedures are involved.…”

“…Upper endoscopy shows clots exiting through the papilla of Vater in 12 to 30% of cases of hemobilia [5]. US, CT and magnetic resonance imaging (MRI) can identify inflammation of the gallbladder, stones, neoplasms and vascular abnormalities, while dynamic CT or MRI can identify the source of active bleeding [2,4,5]. Moreover pre-operative identification of a vascular pseudoaneurysm inside or near the gallbladder can be detected by Doppler US [3], and aneurysms over 1 cm, as in our case, can be found by contrast-enhanced CT scanning [4,6].…”

“…Diagnostic tests reflect the history and clinical presentation of hemobilia [2]. Upper endoscopy shows clots exiting through the papilla of Vater in 12 to 30% of cases of hemobilia [5]. US, CT and magnetic resonance imaging (MRI) can identify inflammation of the gallbladder, stones, neoplasms and vascular abnormalities, while dynamic CT or MRI can identify the source of active bleeding [2,4,5].…”