A woman in her 70s with a history of intraductal papillary mucinous neoplasm developed pancreatic head cancer. We attempted endoscopic retrograde cholangiopancreatography to replace an already implanted biliary plastic stent with a metal stent, but were unsuccessful because of duodenal invasion and stenosis caused by pancreatic head cancer. We removed the existing biliary stent and performed endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS). Seven days after EUS-HGS, the patient developed hematoemesis. Abdominal CT showed hematoma in the stomach and biliary tract; hence, biliary hemorrhage was suspected. We performed abdominal angiography and discovered a pseudoaneurysm coincident with the stent insertion site, and performed coil embolization. There are very few reports of pseudoaneurysm formation and biliary hemorrhage after EUS-HGS. When gastrointestinal bleeding occurs after EUS-HGS, pseudoaneurysm should be assumed and prompt diagnosis and hemostasis should be considered.
