J Korean Soc Radiol.  2012 Jan;66(1):27-33. 10.3348/jksr.2012.66.1.27.

Interventional Management of Delayed and Massive Hemobilia due to Arterial Erosion by Metallic Biliary Stent

• Jeong HS
• Shin TB
• Hwang JC
• Bae JI
• Kim CW

• KMID: 2208867
• DOI: http://doi.org/10.3348/jksr.2012.66.1.27

Abstract

PURPOSE
To evaluate the effectiveness of interventional management for delayed and massive hemobilia secondary to arterial erosion self expandable metallic stent (SES) in with biliary duct malignancy.
MATERIALS AND METHODS
Over 8-year period, eight patients who suffered from delayed massive hemobilia after SES placement for malignant biliary obstruction as palliative procedure, were included. The mean period between SES placement and presence of massive gastrointestinal hemorrhage was 66.5 days (15-152 days), pancreatic cancer (n = 2), Klatskin tumor (n = 2), common bile duct cancer (n = 2), intrahepatic cholangiocarcinoma (n = 1), and gastric cancer with ductal invasion (n = 1). Angiographic findings were pseudoaneurysm (n = 6), contrast extravasation (n = 1) and arterial spasm at segment (n = 1). Six patients underwent embolization of injured vessels using microcoils and N-butyl cyanoacrylate. Two patients underwent stent graft placement at right hepatic artery to prevent ischemic hepatic damage because of the presence of portal vein occlusion.
RESULTS
Massive hemobilia was successfully controlled by the embolization of arteries (n = 6) and stent graft placement (n = 2) without related complications.
CONCLUSION
The delayed massive hemobilia to arterial erosion metallic biliary stent is rare this complication be successfully treated by interventional management.

MeSH Terms

Aneurysm, False
Arteries
Cholangiocarcinoma
Common Bile Duct
Cyanoacrylates
Gastrointestinal Hemorrhage
Hemobilia
Hepatic Artery
Humans
Klatskin's Tumor
Liver Neoplasms
Pancreatic Neoplasms
Portal Vein
Spasm
Stents
Stomach Neoplasms
Transplants
Cholangiocarcinoma
Cholangiocarcinoma
Cyanoacrylates
Liver Neoplasms

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