Rupture of a Hepatic Artery Pseudoaneurysm Induced by Percutaneous Transhepatic Cholangio-Drainage

A Case of Hemobilia Successfully Treated by Transcatheter Arterial Embolization

Abstract

We report a case of hemobilia secondary to rupture of a hepatic artery pseudoaneurysm induced by percutaneous transhepatic cholangio-drainage (PTCD). The patient was a 64-year-old woman, admitted to our hospital complaining of upper abdominal pain and high fever. CT and ultrasonography revealed cholecystitis, and percutaneous transhepatic gallbladder drainage was performed. The cholecystitis improved, but higher total bilirubin values were noted, and MRCP revealed the presence of a stone in the common bile duct. PTCD was performed. When the catheter was inserted, blood drined out of it, but the bleeding stopped within 24 hours. On the 3rd day after PTCD, cholecystectomy and choledocholithotomy were performed. No bleeding was detected during the operation, but hemobilia occurred on the 10th, 64th and 88th days after surgery. On every occasion the bleeding stopped spontaneously. After the 3rd episode of hemobilia, we performed abdominal angiography and detected a pseudoaneurysm. The pseudoaneurysm was no longer seen during the second abdominal angiography examination, and prophylactic embolization was performed with 5 micro-coils. The hemobilia has not recurred since the embolization.