Ann Hepatobiliary Pancreat Surg.  2017 May;21(2):88-92. 10.14701/ahbps.2017.21.2.88.

Hemobilia due to arteriobiliary fistula complicating ERCP for residual bile duct stone in a case of Mirizzi syndrome

• Mathur S
• Thapar V
• Chowda V

• KMID: 2379107
• DOI: http://doi.org/10.14701/ahbps.2017.21.2.88

Abstract

Hemobilia is a rare cause of upper gastrointestinal tract bleeding. Most cases are iatrogenic following medical interventions, most commonly liver biopsy and transhepatic cholangiography. We present a case of arteriobiliary fistula between the right hepatic artery and the common hepatic duct, in a case of Mirrizi syndrome, following endoscopic biliary stenting and presenting with hemobilia. The patient was treated by surgical disconnection of the fistula, ligation of the right hepatic artery, and bilioenteric anastomosis.

Keyword

Gastrointestinal bleeding; Arteriography; Stenting; Cholelithiasis

MeSH Terms

Angiography
Bile Ducts*
Bile*
Biopsy
Cholangiography
Cholangiopancreatography, Endoscopic Retrograde*
Cholelithiasis
Fistula*
Hemobilia*
Hemorrhage
Hepatic Artery
Hepatic Duct, Common
Humans
Ligation
Liver
Mirizzi Syndrome*
Stents
Upper Gastrointestinal Tract

Figure

• 

  Fig. 1 Coronal magnetic resonance image showing 13 mm-sized stone in the mid common bile duct (white arrow).

• 

  Fig. 2 Endoscopic retrograde cholangiopancreaticography showing a filling defect in the mid common bile duct.

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  Fig. 3 Selective hepatic angiogram not showing any leak or pseudoaneurysm.

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  Fig. 4 T2-weighted magnetic resonance image showing stone (black shadow) in cystic duct stump protruding in to the common bile duct (A and B).

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  Fig. 5 Intraoperative photograph showing stone protruding out of the incision made in the cystic duct stump.

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  Fig. 6 Intraoperative photograph showing the direct arteriobiliary fistula between the right hepatic artery (controlled by bulldog clamps) and the lifted common hepatic duct.

Reference

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