Ding Zhen, Tang Xue-Lian, Lin Rong, Han Chaoqun, Liu Jun
Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Medicine (Baltimore). 2017 Sep;96(37):e7716. doi: 10.1097/MD.0000000000007716.
Endoscopic retrograde cholangiopancreatography (ERCP) is the treatment of choice for biliary complications in liver transplantation (LT) recipients as it is both diagnostic and therapeutic. The specific risks following ERCP among LT recipients have not been well studied.
A 56-year-old man with a history of orthotopic LT underwent endoscopic retrograde cholangiopancreatography (ERCP) as a treatment of biliary strictures, whereby a plastic stent was implanted. Thirteen days after ERCP the patient developed multiple episodes of hematemesis.
Digital subtraction angiography (DSA) of the hepatic artery and superior mesenteric artery showed a hepatic pseudoaneurysm (PA) in the left hepatic artery. The final diagnosis was bleeding from the PA.
Interventional embolization of the branch with PA was performed to stop the bleeding.
The patient remained free of GI bleeding for 25 days after interventional embolization, but he developed another bout of bleeding and unfortunately passed away.
ERCP-related complication is not the only cause of post-ERCP bleeding, and that other primary causes should also be ruled out.
内镜逆行胰胆管造影术（ERCP）是肝移植（LT）受者胆道并发症的首选治疗方法，因为它兼具诊断和治疗功能。LT受者接受ERCP后的特定风险尚未得到充分研究。
一名有原位肝移植病史的56岁男性因胆道狭窄接受内镜逆行胰胆管造影术（ERCP），术中植入了塑料支架。ERCP术后13天，患者出现多次呕血。
肝动脉和肠系膜上动脉的数字减影血管造影（DSA）显示左肝动脉有肝假性动脉瘤（PA）。最终诊断为PA出血。
对有PA的分支进行介入栓塞以止血。
介入栓塞后患者25天未再发生胃肠道出血，但随后又出现一次出血，不幸去世。
ERCP相关并发症并非ERCP术后出血的唯一原因，还应排除其他主要原因。
