Abstract
A 75-year-old female was hospitalized with obstructive jaundice due to lymph node metastasis of gallbladder cancer during a course of chemotherapy. Endoscopic retrograde cholangio pancreatography (ERCP) revealed tumor invasion to the bile duct, so a 7Fr plastic stent was placed. Although the patient was discharged in a satisfactory condition, strong abdominal pain appeared 11 days after ERCP. Re-ERCP revealed the plastic stent had naturally dislocated, and the papilla of Vatar was obstructed by a blood clot. The cholangiography showed a filling defect thought to be a clot from an intrabile duct tumor and dilated intrahepatic ducts. Drainage was attempted but not completed as the patient’s respiratory status deteriorated during the procedure. Consequently obstructive jaundice was exacerbated and DIC was observed. ERCP was performed under respirator control on the following day. EST was performed, a clot in the bile duct removed using a balloon, and a covered metallic stent placed across the stricture in order to attempt to stop bleeding and dilate the stricture. Although bleeding ceased, cholangitis and jaundice were not relieved, and ERCP was performed again under respirator control. Cholangiography showed a filling defect due to a clot from intrahepatic ducts to the common bile duct. The clot was cleaned successfully using a balloon without slipping the covered metallic stent, and henceforth bile outflow became smooth. The patient made a good recovery and was discharged. We report here a case of hemobilia successfully treated using a covered metallic stent and bile duct cleaning.
