Mie Takafumi, Sasaki Takashi, Matsueda Kiyoshi, Okamoto Takeshi, Hirai Tatsuki, Ishitsuka Takahiro, Yamada Manabu, Nakagawa Hiroki, Furukawa Takaaki, Takeda Tsuyoshi, Kasuga Akiyoshi, Ozaka Masato, Sasahira Naoki
Department of Hepato-Biliary-Pancreatic Medicine Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan.
Department of Diagnostic Imaging Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan.
DEN Open. 2023 Oct 26;4(1):e304. doi: 10.1002/deo2.304. eCollection 2024 Apr.
We report a case of ruptured cystic artery pseudoaneurysm after self-expandable metal stent placement for malignant biliary obstruction. A 78-year-old woman on palliative care after chemotherapy for unresectable pancreatic head cancer presented with obstructive jaundice. Imaging revealed a dilated common bile duct and an enlarged gallbladder with cystic wall thickening. Endoscopic retrograde cholangiopancreatography was performed and a fully-covered self-expandable metal stent was placed in the bile duct, leading to resolution of jaundice. She presented with hematochezia 7 days later. Contrast-enhanced computed tomography revealed a cystic artery pseudoaneurysm with extravasation of contrast into a blood-filled gallbladder. Hemostasis was achieved after emergent transcatheter arterial embolization. Rupture of cystic artery pseudoaneurysm should be raised as a differential diagnosis for hemobilia after self-expandable metal stent placement, particularly in cases accompanied by inflamed gallbladders.
我们报告一例在自膨式金属支架置入治疗恶性胆道梗阻后发生的胆囊动脉假性动脉瘤破裂病例。一名78岁女性，因不可切除的胰头癌化疗后接受姑息治疗，出现梗阻性黄疸。影像学检查显示胆总管扩张，胆囊增大，胆囊壁增厚。行内镜逆行胰胆管造影术，并在胆管内放置了一个全覆膜自膨式金属支架，黄疸消退。7天后她出现便血。增强计算机断层扫描显示胆囊动脉假性动脉瘤，造影剂外渗至充满血液的胆囊内。紧急经导管动脉栓塞术后实现了止血。胆囊动脉假性动脉瘤破裂应作为自膨式金属支架置入术后胆道出血的鉴别诊断之一，尤其是在伴有胆囊炎症的病例中。
