Korean J Pancreas Biliary Tract.  2025 Apr;30(2):81-86. 10.15279/kpba.2025.30.2.81.

Complications Following SEMS Insertion for Hemobilia Following Impacted Biliary Basket Removal

• Lee H
• Nam HS

• KMID: 2567427
• DOI: http://doi.org/10.15279/kpba.2025.30.2.81

Abstract

There have been rare reports of damage to the blood vessels surrounding the bile duct during the gallstone removal process, causing hemobilia. In cases of severe hemobilia with unstable vital signs, insertion of a fully covered self-expanding metallic stent (SEMS) may be considered as salvage therapy. This case reports a patient with common bile duct stones and acute cholangitis who developed massive hemobilia during attempts to resolve basket device incarceration by performing mechanical lithotripsy. Endoscopic hemostasis was successfully achieved by insertion of a SEMS. However, during follow-up, the stent distally dislocated, resulting in rebleeding with a pseudoaneurysm in the surrounding blood vessels. Ultimately, hemostasis failed despite vascular intervention and additional hemostatic procedures, leading to death. Even if a stent is inserted in an appropriate location, hemostasis may not be achieved well, and if the stent migrates, hemobilia may worsen, so close monitoring is required to determine whether bleeding occurs again.

Keyword

Bile duct diseases; Incarceration; Hemobilia; Stents; Complications; 담도 바스켓 감돈; 혈액 담즙증; 팽창형 금속스텐트; 합병증