Pseudoaneurysm induced by inside stents

Abstract

A 70s man presented at our hospital and two inside stents were placed to address obstructive jaundice associated with hepatocellular carcinoma. 37 days after stenting, epigastric pain appeared. CT scan revealed high-density areas within the gallbladder, suggesting hematoma, leading to suspicion of hemobilia. In an emergency ERCP, upon removal of stent, a significant amount of bleeding was observed from bile duct. Endoscopic Nasobiliary Drainage tubes were placed, and transcatheter arterial embolization (TAE) was performed for the tumor. Despite these interventions, ongoing bleeding and anemia were noted. CT scan showed a pseudoaneurysm and subsequently, a second TAE was performed. Vascular imaging identified a pseudoaneurysm in the right hepatic artery as the source of bleeding, and coil embolization was carried out. Mechanical stimulation from multiple plastic inside stents was considered the cause of pseudoaneurysm formation.