Journal List > J Korean Soc Radiol > v.66(1) > 1087091

TOOLS
Jeong, Shin, Hwang, Bae, and Kim: Interventional Management of Delayed and Massive Hemobilia due to Arterial Erosion by Metallic Biliary Stent
Interventional Radiology
Journal of the Korean Society of Radiology

Journal of the Korean Society of Radiology 2012; 66(1): 27-33.

Published online: 12 January 2012

DOI: https://doi.org/10.0000/jksr.2012.66.1.27

Interventional Management of Delayed and Massive Hemobilia due to Arterial Erosion by Metallic Biliary Stent

Hee-Seok Jeong, MD1, Tae-Beom Shin, MD2, Jae-Cheol Hwang, MD3, Jae-Ik Bae, MD4, Chang-Won Kim, MD5

1Department of Radiology, Gyeongsang National University Hospital, Jinju, Korea.

2Department of Diagnostic Radiology, Kimhae Jung Ang Hospital, Gimhae, Korea.

3Department of Radiology, Ulsan University Hospital, Ulsan, Korea.

4Department of Radiology, Ajou University Hospital, Suwon, Korea.

5Department of Radiology, Pusan National University Hospital, Busan, Korea.

Corresponding author: Tae-Beom Shin, MD. Department of Diagnostic Radiology, Kimhae Jung Ang Hospital, 1044-5 Oe-dong, Gimhae 621-921, Korea. Tel. 82-55-330-6080, Fax. 82-55-330-6100, tbshinkr@yahoo.co.kr

Received 7 September 2011       Accepted 20 October 2011

Copyright © 2012 The Korean Society of Radiology

Abstract

Purpose

To evaluate the effectiveness of interventional management for delayed and massive hemobilia secondary to arterial erosion self expandable metallic stent (SES) in with biliary duct malignancy.

Materials and Methods

Over 8-year period, eight patients who suffered from delayed massive hemobilia after SES placement for malignant biliary obstruction as palliative procedure, were included. The mean period between SES placement and presence of massive gastrointestinal hemorrhage was 66.5 days (15-152 days), pancreatic cancer (n = 2), Klatskin tumor (n = 2), common bile duct cancer (n = 2), intrahepatic cholangiocarcinoma (n = 1), and gastric cancer with ductal invasion (n = 1). Angiographic findings were pseudoaneurysm (n = 6), contrast extravasation (n = 1) and arterial spasm at segment (n = 1). Six patients underwent embolization of injured vessels using microcoils and N-butyl cyanoacrylate. Two patients underwent stent graft placement at right hepatic artery to prevent ischemic hepatic damage because of the presence of portal vein occlusion.

Results

Massive hemobilia was successfully controlled by the embolization of arteries (n = 6) and stent graft placement (n = 2) without related complications.

Conclusion

The delayed massive hemobilia to arterial erosion metallic biliary stent is rare this complication be successfully treated by interventional management.

Keywords: Metallic Biliary Stent, Hemobilia, Intervention

References

1. Winick AB, Waybill PN, Venbrux AC. Complications of percutaneous transhepatic biliary interventions. Tech Vasc Interv Radiol. 2001. 4:200–206.
2. Adam A, Chetty N, Roddie M, Yeung E, Benjamin IS. Self-expandable stainless steel endoprostheses for treatment of malignant bile duct obstruction. AJR Am J Roentgenol. 1991. 156:321–325.
3. L'Hermine C, Ernst O, Delemazure O, Sergent G. Arterial complications of percutaneous transhepatic biliary drainage. Cardiovasc Intervent Radiol. 1996. 19:160–164.
4. Rami P, Williams D, Forauer A, Cwikiel W. Stent-graft treatment of patients with acute bleeding from hepatic artery branches. Cardiovasc Intervent Radiol. 2005. 28:153–158.
5. Savader SJ, Trerotola SO, Merine DS, Venbrux AC, Osterman FA. Hemobilia after percutaneous transhepatic biliary drainage: treatment with transcatheter embolotherapy. J Vasc Interv Radiol. 1992. 3:345–352.
6. Hsu KL, Ko SF, Chou FF, Sheen-Chen SM, Lee TY. Massive hemobilia. Hepatogastroenterology. 2002. 49:306–310.
7. Olcott EW, Saxon RR, Ring EJ, Gordon RL. Catheter tract hemorrhage during percutaneous biliary intervention: management with use of a retained transhepatic guide wire. J Vasc Interv Radiol. 1995. 6:433–438.
8. Rossi P, Bezzi M, Rossi M, Adam A, Chetty N, Roddie ME, et al. Metallic stents in malignant biliary obstruction: results of a multicenter European study of 240 patients. J Vasc Interv Radiol. 1994. 5:279–285.
9. Dunshea TJ, Little AF. Gastrointestinal haemorrhage due to erosion of the duodenal wall by a biliary stent. Australas Radiol. 2005. 49:69–71.
10. Wolters F, Ryan B, Beets-Tan R, Dejong C. Delayed massive hemobilia after biliary stenting. Endoscopy. 2003. 35:976–977.
11. Rai R, Rose J, Manas D. Potentially fatal haemobilia due to inappropriate use of an expanding biliary stent. World J Gastroenterol. 2003. 9:2377–2378.
12. Balsara KP, Dubash C, Shah CR. Pseudoaneurysm of the hepatic artery along with common bile duct injury following laparoscopic cholecystectomy. A report of two cases. Surg Endosc. 1998. 12:276–277.
13. Lennard TW, Plusa SM, Forsythe JL, Richardson DL. Treatment of right hepatic artery injury by percutaneous embolisation. Lancet. 1994. 344:1306–1307.
14. Maleux G, Pirenne J, Aerts R, Nevens F. Case report: hepatic artery pseudoaneurysm after liver transplantation: definitive treatment with a stent-graft after failed coil embolisation. Br J Radiol. 2005. 78:453–456.
15. Miller FJ Jr, Mineau DE. Transcatheter arterial embolization--major complications and their prevention. Cardiovasc Intervent Radiol. 1983. 6:141–149.
16. Paci E, Antico E, Candelari R, Alborino S, Marmorale C, Landi E. Pseudoaneurysm of the common hepatic artery: treatment with a stent-graft. Cardiovasc Intervent Radiol. 2000. 23:472–474.
TOOLS
Similar articles