2023 Volume 65 Issue 2 Pages 132-138
An 87-year-old woman with a history of biliary stenting for common bile duct stones 13 years prior to presentation was admitted for evaluation of lower abdominal pain and gastrointestinal bleeding. Contrast-enhanced computed tomography revealed a stent-stone complex (SCC) in the bile duct; however, no extravascular leakage was detected. Esophagogastroduodenoscopy revealed a choledocho-duodenal fistula with insidious bleeding from the fistula. Abdominal angiography performed for evaluation of recurrent gastrointestinal bleeding revealed a right hepatic artery aneurysm with extravascular leakage from the aneurysm into the common hepatic duct, and transcatheter arterial coil embolization achieved effective hemostasis. Aneurysm formation was attributed to mechanical stimulation secondary to the SCC, with the stent (implanted 13 years prior) forming its core and recurrent cholangitis-induced inflammation.
