Surgical hemostosis for Hemobilia after Endoscopic Biliary Plastic Stent Insertion

Abstract

Hemobilia after endoscopic retrograde cholangiopancreatography (ERCP) is rare, but some severe and fatal hemorrhages have been reported. We recently experienced a case of severe hemobilia and cholangitis after endoscopic biliary plastic stent insertion for the common bile duct stone. The second endoscopy revealed blood spurting from the papilla of Vater. Laboratory data showed anemia and inflammatory findings. Subsequent Computed tomography (CT) showed high density materials in the common bile duct. But there are no lesion of pseudoaneurysm by CT and interventional angiography. Therefore the emergency laparotomy was indicated under a preoperative diagnosis of progressive hemobilia and cholangitis. The intraoperative cholangioscopy showed bleeding and laceration of bile duct. Although late biliary stricture was occurred, the patient recovered after endoscopic balloon dilatation. We describe a rare case of hemobilia after endoscopic biliary plastic stent insertion.