Xu Jianwei, Zhan Hanxiang, Li Feng, Hu Sanyuan, Wang Lei
Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China.
Medicine (Baltimore). 2019 Feb;98(6):e13640. doi: 10.1097/MD.0000000000013640.
Coils migration following endovascular treatment of arterial bleeding is rare. There was no clear route to deal with this complication.
A 55-year-old woman underwent choledochal cyst excision with hepaticojejunostomy. At the 18th day after operation, intra-abdominal hemorrhage occurred. Angiography showed active bleeding of 1 branch of the right hepatic artery and the gastroduodenal artery. That was treated by micro-coils embolization. 122 days after embolization, the patient was readmitted for chills, fever with temperature of 40°C, and jaundice.
Obstructive cholangitis.
Endoscopy was performed, which showed the micro-coils were embedded in biliary-jejunum anastomosis. Biliary sludges were adherent around micro-coils that were considered the cause of obstructive jaundice, which were washed by endoscopy.
Two days later endoscopy therapy, the total bilirubin (TBIL) was decreased to 58.7 μmol/L, and the patient was discharged. After 2 months of follow-up, the level of TBIL was in normal range.
Coils migration following endovascular treatment of arterial bleeding is rare. For cases with coils migrated into the biliary tract, further treatment is often needed because of the secondary cholangitis or stones. Endoscopy might be useful to deal with this intractable problem.
动脉出血血管内治疗后弹簧圈移位罕见。处理这种并发症尚无明确方法。
一名55岁女性接受了胆总管囊肿切除并肝空肠吻合术。术后第18天发生腹腔内出血。血管造影显示右肝动脉1支及胃十二指肠动脉活动性出血，行微弹簧圈栓塞治疗。栓塞后122天，患者因寒战、发热（体温40°C）及黄疸再次入院。
梗阻性胆管炎。
行内镜检查，发现微弹簧圈嵌入胆肠吻合口。微弹簧圈周围附着胆泥，考虑为梗阻性黄疸原因，通过内镜冲洗。
内镜治疗2天后，总胆红素（TBIL）降至58.7μmol/L，患者出院。随访2个月后，TBIL水平在正常范围。
动脉出血血管内治疗后弹簧圈移位罕见。对于弹簧圈移入胆道的病例，由于继发性胆管炎或结石，通常需要进一步治疗。内镜检查可能有助于处理这一棘手问题。
