Hemobilia secondary to hepatic artery pseudoaneurysm: An unusual complication of bile leakage in a patient with a history of a resected IIIb Klatskin tumor

doi:10.3748/wjg.v11.i33.5229

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Sep 7, 2005 (publication date) through Apr 19, 2024

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Sep 7, 2005; 11(33): 5229-5231
Published online Sep 7, 2005. doi: 10.3748/wjg.v11.i33.5229

Hemobilia secondary to hepatic artery pseudoaneurysm: An unusual complication of bile leakage in a patient with a history of a resected IIIb Klatskin tumor

Dimitrios Siablis, Zafiria G. Papathanassiou, Dimitrios Karnabatidis, Nikolaos Christeas, Constantine Vagianos

Dimitrios Siablis, Zafiria G. Papathanassiou, Dimitrios Karnabatidis, Nikolaos Christeas, Department of Interventional Radiology, Medical School, University of Patras, Rio, Greece

Constantine Vagianos, Department of Surgery, Medical School, University of Patras, Rio, Greece

Author contributions: All authors contributed equally to the work.

Correspondence to: Associate Professor, Dimitrios Siablis, MD, Department of Interventional Radiology, Medical School, University of Patras, Rio 26504 Patras, Greece. papaze@otenet.gr

Telephone: +30-2610-999213 Fax: +30-2610-993987

Received: December 19, 2004
Revised: January 23, 2005
Accepted: January 26, 2005
Published online: September 7, 2005

Abstract

We report a case of a 74-year-old woman with a 16-year history of a double bilo-enteric anastomosis due to resected hilar cholangiocarcinoma [Type IIIb Klatskin tumor]. The patient presented with cholangitis secondary to benign anastomotic stenosis which resulted in a large intrahepatic biloma. In order to restore the patency of the anastomosis and overcome cholangitis, several attempts took place, including endobiliary stenting, balloon-assisted biloplasty and transhepatic billiary drainage. Anastomotic patency was achieved, complicated, however, by persistent upper gastro-intestinal bleeding, presented as hemobilia. A biloma-induced pseudoaneurysm of the left hepatic artery was diagnosed. This had ruptured into the biliary tract, and presented the actual cause of the hemobilia. Selective embolism of the pseudoaneurysm resulted in control of the hemorrhage, and was successfully combined with transhepatic dilatation of the anastomosis and percutaneous drainage of the biloma. The patient was ultimately cured and seems to be in excellent condition, 5 mo after treatment.

Keywords: Hepatic artery pseudoaneurysm, Hemobilia, Embolization