Hemobilia after bile duct resection: perforation of pseudoaneurysm into intra-pancreatic remnant bile duct: a case report

• Published in: BMC surgery Vol. 20; no. 1; p. 307
• Main Authors: Yoshida, Kazuhiro, Umeda, Yuzo, Iwamuro, Masaya, Matsumoto, Kazuyuki, Kato, Hironari, Uka, Mayu, Matsui, Yusuke, Yoshida, Ryuichi, Kuise, Takashi, Yasui, Kazuya, Takagi, Kosei, Araki, Hiroyuki, Yagi, Takahito, Fujiwara, Toshiyoshi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 01.12.2020; BioMed Central; BMC
• Subjects: Aged; Ampulla of Vater; Aneurysm, False - diagnostic imaging; Aneurysm, False - etiology; Aneurysm, False - surgery; Angiography; Balloon treatment; Bile; Bile duct resection; Bile ducts; Bile Ducts - surgery; Bleeding; Blood coagulation; Cancer; Case Report; Case reports; Consent; Dentistry; Embolization; Endoscopic balloon tamponade; Endoscopy; Fistula; Gallbladder; Gallbladder cancer; Hemobilia; Hemobilia - etiology; Hemobilia - surgery; Hemostasis; Hemostatics; Hepatectomy; Hepatic Artery - pathology; Humans; Male; Pancreas; Pharmaceutical sciences; Pseudoaneurysm; Surgery; Tamponade; University graduates; Veins & arteries; Japan; Bile duct resection; Case report; Hemobilia; Endoscopic balloon tamponade; Hepatectomy
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-020-00981-8

Hemobilia occurs mainly due to iatrogenic factors such as impairment of the right hepatic or cystic artery, and/or common bile duct in hepatobiliary-pancreatic surgery. However, little or no cases with hemobilia from the intra-pancreatic remnant bile duct after bile duct resection (BDR) has been reported. Here, we report a case of massive hemobilia due to the perforation of psuedoaneurysm of the gastroduodenal artery (GDA) to the intra-pancreatic remnant bile duct after hepatectomy with BDR. A 68-year-old male underwent extended right hepatectomy with BDR for gallbladder carcinoma. He presented with upper gastrointestinal bleeding 2 months after the initial surgery. Upper endoscopy identified a blood clot from the ampulla of Vater and simultaneous endoscopic balloon tamponade contributed to temporary hemostasis. Abdominal CT and angiography revealed a perforation of the psuedoaneurysm of the GDA to the intra-pancreatic remnant bile duct resulting in massive hemobilia. Subsequent selective embolization of the pseudoaneurysm with micro-coils could achieve complete hemostasis. He survived without any recurrence of cancer and bleeding. Hemobilia could occur in a patient with BDR due to perforation of the pseudoaneurysm derived from the GDA to the intra-pancreatic remnant bile duct. Endoscopic balloon tamponade was useful for a temporal hemostasis and a subsequent radiologic interventional approach.