Korean J Pancreas Biliary Tract.  2023 Jul;28(3):81-88. 10.15279/kpba.2023.28.3.81.

Two Cases of Life-Threatening Hemobilia Following Removal of Biliary Stents Treated with Covered Self-Expandable Metal Stents

• Woo JH
• Kim J
• Choi JH
• Kang J
• Paik WH
• Ryu JK
• Kim YT
• Lee SH

• KMID: 2544817
• DOI: http://doi.org/10.15279/kpba.2023.28.3.81

Abstract

Biliary stent removal can cause hemobilia due to injury to the adjacent vessel, but it is rarely reported. If significant hemobilia occurs during stent removal, samesession covered self-expandable metal stent (CSEMS) insertion may be useful as a rescue or bridge therapy before angiography. Here, we report two cases of lifethreatening hemobilia following stent removal successfully treated by CSEMS. The first case was a Klatskin tumor bismuth type IV patient who required biliary stenting for resolving malignant biliary obstruction. The second case was a hepatocellular carcinoma patient who had undergone multiple transarterial chemoembolization and required biliary stents for liver abscess. In this situation, inserting a CSEMS at a higher level than the expected bleeding site and recognizing stenting as a temporary therapy with its limitations are important. Also, it is crucial to consider pre-procedural imaging in high-risk patients, and perform post-procedural imaging to evaluate for ongoing bleeding or vascular abnormalities.

Keyword

Hemobilia; Biliary stent; Covered self-expandable metal stent; Angiography; Pseudoaneurysm; 혈액 담즙증; 담도 스텐트; 피막형 팽창성 금속 스텐트; 혈관조영술; 가성동맥류