Hemobilia confirmed with endoscope following bile duct metallic stent placement

Abstract

A 65-year-old man underwent Billroth II surgery and was referred to our department for jaundice. Our diagnosis was cancer of the pancreatic head, so we placed a bare metallic stent in the bile duct. We performed endoscope because of melena but findings were unremarkable. Laboratory investigations revealed anemia and inflammation. Dynamic computed tomography showed no aneurysmor contrast extravasation. Endoscope revealed hemobilia, so we performed endoscopic retrograde cholangiopancreatography and replaced a plastic stent in the bile duct for drainage. We used a gastroscope to observe the lumen of the bile duct, noted oozing from the metallic stent in the duct distally, and achieved hemostasis by placing a covered metallic stent. This case of hemobilia was successfully confirmed using endoscope.