Tien T, Tan Y C, Baptiste P, Tanwar S
Department of Gastroenterology, Whipps Cross Hospital, Barts Health NHS Trust, London, UK.
General Practice, NHS Waltham Forest Clinical Commissioning Group, London, UK.
Oxf Med Case Reports. 2020 Feb 28;2020(2):omaa010. doi: 10.1093/omcr/omaa010. eCollection 2020 Feb.
Haemobilia describes blood loss from the biliary tract and classically presents as Quincke's triad: upper gastrointestinal bleeding (UGIB), jaundice and right upper quadrant abdominal pain. We discuss the case of a 70-year-old male with a previously stented Bismuth 1 hilar cholangiocarcinoma who presented with haematemesis. He had a similar presentation a month ago where a forward viewing gastroscope identified fresh and altered blood in the distal stomach but no clear source of bleeding. During this admission, a side-viewing duodenoscope identified bleeding from the periampullary region, which was managed by inserting a fully covered self-expanding metal stent (fcSEMS) within his pre-existing uncovered SEMS to tamponade the haemorrhage. This case highlights the importance of using a side-viewing duodenoscope for patients with UGIB on a background of a stented cholangiocarcinoma and inserting a fcSEMS within an uncovered SEMS is feasible and effective in managing these patients.
胆道出血是指胆道系统的出血，典型表现为昆克三联征：上消化道出血（UGIB）、黄疸和右上腹腹痛。我们讨论一例70岁男性病例，该患者既往患有支架置入的毕氏I型肝门部胆管癌，此次因呕血就诊。一个月前他有过类似表现，当时前视胃镜检查发现胃远端有新鲜和陈旧性血液，但未明确出血源。在此次住院期间，侧视十二指肠镜检查发现壶腹周围区域出血，通过在其原有的未覆膜自膨式金属支架（fcSEMS）内插入一个全覆膜自膨式金属支架来压迫出血进行处理。该病例强调了对于患有支架置入胆管癌背景下发生上消化道出血的患者使用侧视十二指肠镜的重要性，并且在未覆膜自膨式金属支架内插入全覆膜自膨式金属支架在处理这些患者时是可行且有效的。
