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经皮肝活检后并发急性胆囊炎的动脉门静脉瘘所致的胆道出血及文献复习

Hemobilia Caused by Arterioportal Fistula Following Percutaneous Liver Biopsy Complicated by Acute Cholecystitis and Review of the Literature.

作者信息

Ioannidis Orestis, Malliora Anastasia, Christidis Panagiotis, Pramateftakis Manousos George, Kotidis Efstathios, Mantzoros Ioannis, Ouzounidis Nikolaos, Foutsitzis Vasilis, Angelopoulos Stamatios

机构信息

4Academic Department of Surgery, School of Medicine, Aristotle University of Thessaloniki, Greece.

出版信息

Curr Health Sci J. 2022 Apr-Jun;48(2):235-241. doi: 10.12865/CHSJ.48.02.15. Epub 2022 Jun 30.

DOI:10.12865/CHSJ.48.02.15
PMID:36320869
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9590359/
Abstract

We present a case of a 44-year-old male with chronic hepatitis B that visited the Emergency Department due to epigastric pain after a liver biopsy. The ultrasonography revealed signs of bleeding in the bile ducts. and angiography visualized an arterioportal fistula. Selective right hepatic artery branch embolization was performed, and the bleeding was controlled. Although, the clinical picture was initially improved, the patient presented later with acute abdomen, obstructive jaundice and fever. The patient underwent cholecystectomy with bile duct exploration and placement of a Kehr's T tube in the common bile duct. The postoperative course was uneventful. We also review the relevant literature concerning arterioportal fistula manifested as hemobilia as well as acute cholecystitis occurring after hemobilia.

摘要

我们报告一例44岁慢性乙型肝炎男性患者，该患者在肝活检后因上腹部疼痛就诊于急诊科。超声检查显示胆管有出血迹象，血管造影显示存在动门脉瘘。进行了选择性右肝动脉分支栓塞，出血得到控制。尽管患者的临床症状最初有所改善，但后来出现了急腹症、梗阻性黄疸和发热。患者接受了胆囊切除术，术中探查胆管并在胆总管放置了凯尔氏T管。术后过程顺利。我们还回顾了有关表现为胆道出血的动门脉瘘以及胆道出血后发生急性胆囊炎的相关文献。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e92/9590359/a0b885cbaa27/CHSJ-48-02-235-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e92/9590359/eb36e8f1ad0c/CHSJ-48-02-235-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e92/9590359/3fd359b6bef2/CHSJ-48-02-235-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e92/9590359/a0b885cbaa27/CHSJ-48-02-235-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e92/9590359/eb36e8f1ad0c/CHSJ-48-02-235-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e92/9590359/3fd359b6bef2/CHSJ-48-02-235-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e92/9590359/a0b885cbaa27/CHSJ-48-02-235-fig3.jpg

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Hemobilia Caused by Arterioportal Fistula Following Percutaneous Liver Biopsy Complicated by Acute Cholecystitis and Review of the Literature.经皮肝活检后并发急性胆囊炎的动脉门静脉瘘所致的胆道出血及文献复习
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本文引用的文献

1
Incidence and Consequence of Nontarget Embolization Following Bland Hepatic Arterial Embolization.非靶器官栓塞的发生率及后果。 Bland 肝动脉栓塞后的非靶器官栓塞。
Cardiovasc Intervent Radiol. 2019 Aug;42(8):1135-1141. doi: 10.1007/s00270-019-02229-2. Epub 2019 May 9.
2
Arterial-Portal Fistula After Percutaneous Liver Biopsy in Hepatic Allograft Causing Hemobilia and Pancreatitis.
Clin Gastroenterol Hepatol. 2017 Jan;15(1):e3-e4. doi: 10.1016/j.cgh.2016.07.014. Epub 2016 Jul 21.
3
The clinical anatomy of cystic artery variations: a review of over 9800 cases.胆囊动脉变异的临床解剖学：对9800多例病例的回顾
Surg Radiol Anat. 2016 Jul;38(5):529-39. doi: 10.1007/s00276-015-1600-y. Epub 2015 Dec 23.
4
Successful transarterial embolization for recurrent pseudoaneurysm of the right hepatic artery with acute cholecystitis.经动脉栓塞术成功治疗右肝动脉复发性假性动脉瘤合并急性胆囊炎
Clin J Gastroenterol. 2014 Apr;7(2):164-9. doi: 10.1007/s12328-013-0450-6. Epub 2014 Jan 17.
5
Hemobilia and other complications caused by percutaneous ultrasound-guided liver biopsy.经皮超声引导下肝活检引起的胆道出血及其他并发症。
World J Gastroenterol. 2014 Apr 7;20(13):3712-5. doi: 10.3748/wjg.v20.i13.3712.
6
Ischemic gall bladder perforation: a complication of type A aortic dissection.缺血性胆囊穿孔：A型主动脉夹层的一种并发症。
Ann Thorac Surg. 2013 Jun;95(6):e155-6. doi: 10.1016/j.athoracsur.2012.11.055.
7
Emergency cholecystectomy and hepatic arterial repair in a patient presenting with haemobilia and massive gastrointestinal haemorrhage due to a spontaneous cystic artery gallbladder fistula masquerading as a pseudoaneurysm.因自发性胆囊动脉瘘（假性动脉瘤）导致胆血反流和大量胃肠道出血的患者行急诊胆囊切除术和肝动脉修复术。
BMC Gastroenterol. 2013 Mar 3;13:43. doi: 10.1186/1471-230X-13-43.
8
Cholecystitis, pancreatitis and hemobilia: a serious trilogy after liver biopsy.
Pediatr Int. 2010 Aug;52(4):e215-7. doi: 10.1111/j.1442-200X.2010.03175.x.
9
Massive hemobilia after transjugular liver biopsy treated endoscopically and angiographically.经颈静脉肝活检后发生大量胆道出血，采用内镜和血管造影方法进行治疗。
Clin Gastroenterol Hepatol. 2008 Dec;6(12):A30. doi: 10.1016/j.cgh.2008.06.013.
10
Fatal hemobilia resulting from an iatrogenic arteriobiliary fistula as a rare complication of transjugular liver biopsy.医源性肝动脉胆管瘘导致的致命性胆道出血是经颈静脉肝活检罕见的并发症。
Eur J Gastroenterol Hepatol. 2008 Jan;20(1):83-6. doi: 10.1097/MEG.0b013e3282748f32.