Ma Zhen-Wei, Gong Xiao-Jun, Chen Yong-Jun, Wang Bing
Department of General Surgery, The Fifth Hospital of Wuhan, Wuhan 430000, Hubei Province, China.
Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, Hubei Province, China.
World J Gastrointest Endosc. 2025 Aug 16;17(8):111141. doi: 10.4253/wjge.v17.i8.111141.
Post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding is a serious complication, and related case reports have described various bleeding events following ERCP, including injury to the right gastroepiploic artery, bleeding from biliary varices, retroperitoneal hematoma in liver transplant recipients and subcapsular liver hematoma after ERCP.
We present a case of a 55-year-old male patient who developed post-ERCP hemorrhage one month after undergoing ERCP, endoscopic sphincterotomy, and bile duct stone removal for acute biliary pancreatitis. The patient presented with upper abdominal pain and melena, and imaging studies revealed high-density shadows in the intrahepatic bile duct, gallbladder, and lower segment of the common bile duct, suggestive of bleeding. Emergency interventional embolization was performed, and subsequent endoscopic and interventional therapies were implemented to control the bleeding. The patient's hemoglobin levels gradually improved, and biliary indicators normalized.
Post-ERCP bleeding can result from various etiologies, and the rupture of variant vessels is a noteworthy topic warranting further exploration.
内镜逆行胰胆管造影术（ERCP）后出血是一种严重的并发症，相关病例报告描述了ERCP后的各种出血事件，包括胃网膜右动脉损伤、胆静脉曲张出血、肝移植受者的腹膜后血肿以及ERCP后的肝包膜下血肿。
我们报告一例55岁男性患者，在因急性胆源性胰腺炎接受ERCP、内镜括约肌切开术和胆管结石清除术后1个月发生ERCP后出血。患者出现上腹部疼痛和黑便，影像学检查显示肝内胆管、胆囊和胆总管下段有高密度影，提示出血。进行了紧急介入栓塞，并随后实施了内镜和介入治疗以控制出血。患者的血红蛋白水平逐渐改善，胆汁指标恢复正常。
ERCP后出血可由多种病因引起，变异血管破裂是一个值得进一步探讨的重要课题。
