Ipek Serkan
Department of Gastroenterology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
Arch Clin Cases. 2025 Mar 25;12(1):34-36. doi: 10.22551/2025.46.1201.10309. eCollection 2025.
Hemobilia is a potentially fatal condition if not diagnosed and treated early. One of the rare causes of hemobilia is hepatic artery pseudoaneurysm. Herein, we present a case of hemobilia caused by hepatic artery pseudoaneurysm rupture. A patient with a benign stricture in the distal common bile duct who had undergone multiple endoscopic retrograde cholangiopancreatography (ERCP) procedures had a pigtail stent placed during the last ERCP. Ten days after the procedure, the patient presented to our emergency department with abdominal pain and was admitted with a diagnosis of acute pancreatitis. During follow-up, the patient underwent another ERCP due to suspected cholangitis, and severe hemobilia was observed following removal of the pigtail stent. Computed tomography (CT) angiography revealed a hepatic artery pseudoaneurysm, which was successfully treated with coil embolization. Patients with hemobilia may present with symptoms of upper gastrointestinal bleeding as well as conditions such as cholangitis and pancreatitis due to hepatic artery pseudoaneurysm rupture. Coil embolization is the first-line of interventional to stop bleeding. If this method is insufficient, surgical treatment may be considered.
如果不早期诊断和治疗，胆道出血是一种潜在的致命病症。肝动脉假性动脉瘤是胆道出血的罕见病因之一。在此，我们报告一例由肝动脉假性动脉瘤破裂引起的胆道出血病例。一名胆总管远端良性狭窄患者接受了多次内镜逆行胰胆管造影（ERCP）手术，在最后一次ERCP手术期间放置了猪尾支架。术后十天，患者因腹痛就诊于我院急诊科，以急性胰腺炎诊断入院。在随访期间，患者因疑似胆管炎接受了另一次ERCP检查，在拔除猪尾支架后观察到严重的胆道出血。计算机断层扫描（CT）血管造影显示肝动脉假性动脉瘤，通过弹簧圈栓塞成功治疗。胆道出血患者可能表现为上消化道出血症状以及因肝动脉假性动脉瘤破裂导致的胆管炎和胰腺炎等病症。弹簧圈栓塞是止血的一线介入治疗方法。如果这种方法不足，可以考虑手术治疗。
