A case of hemobilia after endoscopic placement of biliary self-expandable metallic stent

Abstract

Many publications report iatrogenic hemobilia─such as complications of percutaneous transhepatic procedures─but there are few reports of hemobilia induced by endoscopic biliary metallic stenting. Here we describe a case of hemobilia with hepatic pseudoaneurysm after placement of a self-expandable metallic stent (SEMS) for malignant biliary obstruction, treated by transcatheter arterial embolization (TAE) .
An 84-year-old male with unresectable hilar cholangiocarcinoma received an uncovered biliary SEMS and placement of two percutaneous biliary drainage tubes. Fifty-seven days after SEMS placement, the patient developed severe melena and shock. Abdominal CT scan identified a hepatic pseudoaneurysm into the SEMS, which was treated by TAE.
Although it is thought that hemobilia usually improves with conservative treatment, it may be better to perform hemostatic treatments such as TAE in cases complicated by pseudoaneurysm associated with SEMS.