Yamauchi Kenji, Uchida Daisuke, Kato Hironari, Okada Hiroyuki
Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan.
Intern Med. 2018 Jan 1;57(1):49-52. doi: 10.2169/internalmedicine.8983-17. Epub 2017 Oct 16.
A 78-year-old woman was admitted with benign biliary stenosis. A plastic stent was placed at the left branch to prevent obstructive cholangitis. Two weeks after the procedure, the patient was readmitted with cholangitis caused by hemobilia. However, computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), peroral cholangioscopy, and abdominal angiography failed to establish the bleeding source. At the seventh bleeding, CT revealed a hepatic artery pseudoaneurysm for which coil embolization was successfully performed. Hemobilia after plastic stent placement is extremely rare. We urge clinicians to consider the possibility of a pseudoaneurysm near the stent when trying to identify the bleeding source.
一名78岁女性因良性胆管狭窄入院。在左肝支放置了一个塑料支架以预防梗阻性胆管炎。术后两周，患者因胆道出血引起的胆管炎再次入院。然而，计算机断层扫描（CT）、内镜逆行胰胆管造影（ERCP）、经口胆管镜检查和腹部血管造影均未能确定出血源。在第七次出血时，CT显示肝动脉假性动脉瘤，成功进行了弹簧圈栓塞。塑料支架置入后胆道出血极为罕见。我们敦促临床医生在试图确定出血源时考虑支架附近假性动脉瘤的可能性。
