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1.
Medicina (Kaunas) ; 60(5)2024 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-38792887

RESUMO

Background and Objectives: Transarterial chemoembolization (TACE) is a widely accepted treatment for hepatocellular carcinoma (HCC). Regarding TACE, arterial injuries, such as hepatic artery spasm or dissection, can also occur, although pseudoaneurysms are rare. We report a case of pseudoaneurysm following TACE. Materials and Methods: A 78-year-old man had been undergoing TACE for HCC in segment 8 of the liver for the past 5 years, with the most recent TACE procedure performed approximately 1 month prior. He presented to the emergency department with melena that persisted for 5 days. Computed tomography revealed a pseudoaneurysm in the S8 hepatic artery with hemobilia. Results: the pseudoaneurysm was successfully treated by N-Butyl-cyanoacrylate glue embolization. Conclusions: In patients that have undergone TACE presenting with melena and hemobilia identified on CT, consideration of hepatic artery pseudoaneurysm is crucial. Such cases can be safely and effectively treated with endovascular managements.


Assuntos
Falso Aneurisma , Carcinoma Hepatocelular , Quimioembolização Terapêutica , Artéria Hepática , Neoplasias Hepáticas , Humanos , Falso Aneurisma/terapia , Falso Aneurisma/etiologia , Masculino , Idoso , Quimioembolização Terapêutica/métodos , Quimioembolização Terapêutica/efeitos adversos , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/terapia , Tomografia Computadorizada por Raios X , Procedimentos Endovasculares/métodos , Embolização Terapêutica/métodos , Resultado do Tratamento , Hemobilia/etiologia , Hemobilia/terapia
2.
Gan To Kagaku Ryoho ; 50(4): 505-507, 2023 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-37066469

RESUMO

A 79-year-old man was scheduled for surgery for hepatocellular carcinoma(HCC)after transcatheter hepatic arterial embolization for rupture. Two weeks before surgery, the patient came to our hospital with a chief complaint of back pain. First, we performed biliary drainage, under the diagnosis of HCC with obstructive jaundice due to haemobilia. Hepatectomy was performed when the patient's condition stabilized. It should be kept in mind that haemobilia may occur after TAE for HCC with bile duct tumor thrombus, and appropriate treatment should be performed when bleeding occurs.


Assuntos
Carcinoma Hepatocelular , Embolização Terapêutica , Hemobilia , Neoplasias Hepáticas , Masculino , Humanos , Idoso , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/patologia , Artéria Hepática/patologia , Procedimentos Cirúrgicos Vasculares , Hemobilia/etiologia , Hemobilia/terapia
3.
Khirurgiia (Mosk) ; (4): 77-82, 2023.
Artigo em Russo | MEDLINE | ID: mdl-37850899

RESUMO

Hepatic artery aneurysms (HAA) are rare (20% of all visceral arteries). Most often, HAAs are asymptomatic and detected at autopsy. However, their ruptures and/or bleeding following pressure ulcers in visceral gastrointestinal organs are a significant clinical and diagnostic problem. We present 2 patients with obstructive jaundice and hemobilia. Diagnostics revealed aneurysm of the right hepatic artery with arterio-biliary fistula. Life-threatening hemobilia is a consequence of HAA rupture into biliary system. Endovascular approach is preferable for HAA without clinical manifestations. Awareness of this disease is important for early detection and active surgical intervention before possible complications.


Assuntos
Aneurisma , Fístula Biliar , Hemobilia , Icterícia Obstrutiva , Humanos , Fístula Biliar/diagnóstico , Fístula Biliar/etiologia , Fístula Biliar/cirurgia , Hemobilia/etiologia , Hemobilia/complicações , Aneurisma/cirurgia , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/cirurgia , Icterícia Obstrutiva/diagnóstico , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/cirurgia
4.
Acta Radiol ; 63(3): 360-367, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33562997

RESUMO

BACKGROUND: Massive hemobilia is a life-threatening condition and therapeutic challenge. Few studies have demonstrated the use of N-butyl cyanoacrylate (NBCA) for massive hemobilia. PURPOSE: To investigate the efficacy and safety of transcatheter arterial embolization (TAE) using NBCA Glubran 2 for massive hemobilia. MATERIAL AND METHODS: Between January 2012 and December 2019, the data of 26 patients (mean age 63.4 ± 12.6 years) with massive hemobilia were retrospectively evaluated for TAE using NBCA. The patients' baseline characteristics, severities of hemobilia, and imaging findings were collected. Emergent TAE was performed using 1:2-1:4 mixtures of NBCA and ethiodized oil. Technical success, clinical success, procedure-related complications, and follow-up outcomes were assessed. RESULTS: Pre-procedure arteriography demonstrated injuries to the right hepatic artery (n = 24) and cystic artery (n = 2). Initial coil embolization distal to the lesions was required in 5 (19.2%) patients to control high blood flow and prevent end-organ damage. After a mean treatment time of 11.2 ± 5.3 min, technical success was achieved in 100% of the patients without non-target embolization and catheter adhesion. Clinical success was achieved in 25 (96.2%) patients. Major complications were noted in 1 (3.8%) patient with gallbladder necrosis. During a median follow-up time of 16.5 months (range 3-24 months), two patients died due to carcinomas, whereas none of the patients experienced recurrent hemobilia, embolic material migration, or post-embolization complications. CONCLUSION: NBCA embolization for massive hemobilia is associated with rapid and effective hemostasis, as well as few major complications. This treatment modality may be a promising alternative to coil embolization.


Assuntos
Embolização Terapêutica/métodos , Embucrilato/administração & dosagem , Hemobilia/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia , Catéteres , Embolização Terapêutica/efeitos adversos , Embucrilato/efeitos adversos , Óleo Etiodado/administração & dosagem , Feminino , Hemobilia/diagnóstico por imagem , Hemobilia/etiologia , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento
5.
Emerg Radiol ; 29(6): 1049-1053, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35819737

RESUMO

Delayed hemobilia, a rare but potentially fatal complication of endoscopic metallic stenting for malignant biliary obstruction, requires prompt identification of the source of bleeding and subsequent embolization. However, hemobilia is characteristically intermittent, and computed tomography (CT) often fails to show pseudoaneurysms or extravasations. In particular, because the posterior superior pancreaticoduodenal artery (PSPDA) runs alongside the common bile duct for its whole length, it is readily obscured by metallic artifacts in that duct, such as stents, making identification of the source of bleeding by CT difficult. We have encountered three patients with delayed hemobilia from the PSPDA following endoscopic biliary stenting for malignant biliary obstruction in whom no extravasation or pseudoaneurysms were detected by contrast-enhanced CT during bleeding. However, when we identified that the PSPDA had a smaller diameter than in previous CTs in all three cases, we suspected that the PSPDA was the source of the bleeding. No extravasation or pseudoaneurysms were detected with celiac arteriography or superior mesenteric arteriography; however, extravasation and pseudoaneurysms were detected by direct PSPDA angiography. Hemostasis was achieved through embolization. Detecting a large decrease in the diameter of the PSPDA on contrast-enhanced CT during biliary bleeding may help to identify the source of that bleeding.


Assuntos
Falso Aneurisma , Colestase , Embolização Terapêutica , Hemobilia , Humanos , Hemobilia/diagnóstico por imagem , Hemobilia/etiologia , Hemobilia/terapia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Artéria Hepática , Stents/efeitos adversos , Embolização Terapêutica/métodos , Colestase/complicações
6.
Rev Esp Enferm Dig ; 114(8): 502-503, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35285661

RESUMO

A 60-year-old woman with autoimmune hepatitis submitted to liver transplantation presented with a biliary anastomotic stenosis. An endoscopic retrograde cholangiopancreatography (ERCP) was complicated with a porto-biliary fistula due to the misplacement of a biliary stent. After multidisciplinary discussion, and the stent was endoscopically removed while a percutaneous transhepatic fully-covered self-expanded metal stent was placed in portal vein. Iatrogenic porto-biliary fistula following biliary stent placement is a rare and potentially life-threatening ERCP complication. In a suspected stent-related portal vein injury, this multidisciplinary strategy combining gastroenterology and radiology proved to be an effective and safe minimally invasive technique avoiding catastrophic consequences.


Assuntos
Fístula Biliar , Colestase , Hemobilia , Transplante de Fígado , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/etiologia , Fístula Biliar/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colestase/complicações , Feminino , Hemobilia/diagnóstico por imagem , Hemobilia/etiologia , Hemobilia/terapia , Humanos , Transplante de Fígado/efeitos adversos , Pessoa de Meia-Idade , Stents/efeitos adversos
7.
Minim Invasive Ther Allied Technol ; 31(4): 603-608, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33612051

RESUMO

PURPOSE: To evaluate the safety and efficacy of percutaneous stone removal using a compliant balloon after papillary balloon dilatation. MATERIAL AND METHODS: Between March 2014 and May 2020, 123 patients with choledocholithiasis, in whom endoscopy was unsuccessful, were enrolled in this study. The ampulla of Vater was dilated using a noncompliant balloon, and stone removal was attempted via a pushing maneuver using an endoscopic stone extraction balloon. Clinical and technical success rates, complications, and risk factors for failure and complications were evaluated. RESULTS: Biliary stones were completely removed in 118 of 123 patients. Major complications occurred in five patients. One patient experienced duodenal bleeding, which was successfully treated by endoscopy. Hemobilia occurred in three patients, which required transfusion, and one patient experienced four days of abdominal pain. Minor complications, including self-limiting pain, effusion, minimal hemobilia, elevated amylase and fever, occurred in 21 patients. Stone size was the only significant risk factor associated with the rate of complications (Odds ratio: 1.14, 95% confidence interval = 1.04, 1.26). Bilirubin and white blood cell levels significantly decreased after the procedure. CONCLUSION: Percutaneous stone removal using a compliant balloon after papillary balloon dilatation is a safe and effective method in patients in whom endoscopic or surgical treatment is not feasible. Abbreviations: ERCP: endoscopic retrograde cholangiopancreatography; PTBD: percutaneous transhepatic biliary drainage.


Assuntos
Cateterismo , Cálculos Renais , Cateterismo/efeitos adversos , Cateterismo/métodos , Dilatação/métodos , Hemobilia/etiologia , Humanos , Cálculos Renais/terapia , Estudos Retrospectivos , Resultado do Tratamento
8.
Nihon Shokakibyo Gakkai Zasshi ; 119(8): 768-775, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-35944995

RESUMO

A 78-year-old man came to our department because of obstructive jaundice, and was diagnosed as pancreatic head cancer. He underwent chemoradiation therapy. A metal stent was inserted into the common bile duct and the patient was followed up on an outpatient basis. The patient visited our emergency department 46 days after stent insertion due to abdominal pain. The patient was diagnosed with ruptured pseudoaneurysm of the superior pancreaticoduodenal artery by angiography and treated with coil embolization. He died due to sudden deterioration the next day. Pathological autopsy revealed that the cause of the ruptured pseudoaneurysm appeared to be vasculopathy due to radiation therapy.


Assuntos
Falso Aneurisma , Embolização Terapêutica , Hemobilia , Neoplasias Pancreáticas , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Autopsia , Quimiorradioterapia/efeitos adversos , Embolização Terapêutica/efeitos adversos , Hemobilia/etiologia , Humanos , Masculino , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/terapia , Neoplasias Pancreáticas
9.
Radiographics ; 41(3): 802-813, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33939540

RESUMO

Hemobilia, or hemorrhage within the biliary system, is an uncommon form of upper gastrointestinal (GI) bleeding that presents unique diagnostic and therapeutic challenges. Most cases are the result of iatrogenic trauma, although accidental trauma and a variety of inflammatory, infectious, and neoplastic processes have also been implicated. Timely diagnosis can often be difficult, as the classic triad of upper GI hemorrhage, biliary colic, and jaundice is present in a minority of cases, and there may be considerable delay in the onset of bleeding after the initial injury. Therefore, the radiologist must maintain a high index of suspicion for this condition and be attuned to its imaging characteristics across a variety of modalities. CT is the first-line diagnostic modality in evaluation of hemobilia, while catheter angiography and endoscopy play vital and complementary roles in both diagnosis and treatment. The authors review the clinical manifestations and multimodality imaging features of hemobilia, describe the wide variety of underlying causes, and highlight key management considerations.©RSNA, 2021.


Assuntos
Doenças da Vesícula Biliar , Hemobilia , Angiografia , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/terapia , Hemobilia/diagnóstico por imagem , Hemobilia/etiologia , Hemobilia/terapia , Humanos
10.
Ann Vasc Surg ; 71: 536.e1-536.e4, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33157248

RESUMO

INTRODUCTION: Hepatic artery aneurysm (HAA) is a rare occurrence. Quincke's triad of hemobilia; abdominal pain, obstructive jaundice, and upper gastrointestinal (GI) bleeding could be detected in one-third of HAA patients. CASE PRESENTATION: We present a case of HAA with all signs of Quincke's triad and shock. The diagnosis of HAA was enforced by CT angiography. An urgent open surgical approach was elected by the surgical team. The patient underwent an uneventful resection of the HAA, and primary repair of the CHA followed with bilioenteric reconstruction. CONCLUSIONS: Recognizing the signs of Quincke's triad aids in prompt diagnosis of hemobilia in HAA, which suggests a rupture of the aneurysm or fistula formation into the biliary tree that would need urgent management by both vascular and HBP surgeons.


Assuntos
Aneurisma Roto/complicações , Fístula Biliar/etiologia , Hemobilia/etiologia , Artéria Hepática , Icterícia Obstrutiva/etiologia , Dor Abdominal/etiologia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar , Hemorragia Gastrointestinal/etiologia , Hemobilia/diagnóstico por imagem , Hemobilia/cirurgia , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/cirurgia , Humanos , Icterícia Obstrutiva/diagnóstico por imagem , Icterícia Obstrutiva/cirurgia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
11.
BMC Surg ; 21(1): 318, 2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34353316

RESUMO

BACKGROUND: Hemobilia refers to bleeding into the biliary tract. Hepatic artery pseudoaneurysm (HAP) rupture is an uncommon cause of hemobilia, and cases of HAP associated with Mirizzi syndrome are extremely rare. Although transarterial embolization is recommended as the first-line treatment for hemobilia, surgery is sometimes required. CASE PRESENTATION: A 76-year-old woman was referred to our hospital with epigastric pain. She was febrile and had conjunctival icterus and epigastric tenderness. Laboratory tests revealed abnormal white blood cell count and liver function. An abdominal computed tomography (CT) revealed multiple calculi in the gallbladder, an incarcerated calculus in the cystic duct, and a slightly dilated common hepatic duct. Based on examination findings, she was diagnosed with Mirizzi syndrome type I, complicated by cholangitis. Intravenous antibiotics were administered, and we performed endoscopic retrograde cholangiopancreatography (ERCP) to place a drainage tube. The fever persisted; therefore, contrast-enhanced CT (CECT) was performed. This revealed portal vein thrombosis and hepatic abscesses; therefore, heparin infusion was administered. The following day, she complained of melena, and laboratory tests showed that she was anemic. ERCP was performed to change the drainage tube in the bile duct; however, bleeding from the papilla of Vater was observed. CECT demonstrated a right HAP with high-density fluid in the gallbladder and gallbladder perforation. Finally, she was diagnosed with hemobilia caused by HAP rupture, and emergency surgery was performed to secure hemostasis and control the infection. During laparotomy, we found that a right HAP had ruptured into the gallbladder. The gallbladder made a cholecystobiliary fistula, which indicated Mirizzi syndrome type II. Although we tried to repair the right hepatic artery, we later ligated it due to arterial wall vulnerability. Then, we performed subtotal cholecystectomy and inserted a T-tube into the common bile duct. There were no postoperative complications except for minor leakage from the T-tube insertion site. The patient was discharged after a total hospital stay of 7 weeks. CONCLUSIONS: We experienced an extremely rare case of emergency definitive surgery for hemobilia due to HAP rupture complicated by Mirizzi syndrome type II. Surgery might be indicated when controlling underlying infections was required.


Assuntos
Falso Aneurisma , Hemobilia , Síndrome de Mirizzi , Idoso , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Feminino , Hemobilia/etiologia , Hemobilia/cirurgia , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/cirurgia , Ducto Hepático Comum , Humanos , Fígado , Síndrome de Mirizzi/cirurgia
12.
BMC Surg ; 21(1): 71, 2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33530973

RESUMO

BACKGROUND: Hemobilia due to rupture of hepatic artery pseudoaneurysm and recurrent hemorrhage caused by hepatic artery collateral circulation are both rare complications after liver trauma. There have been a number of separate reports of both complications, but no cases have been reported in which the two events occurred in the same patient. Here we report a recurrent hemorrhage in the bile duct due to hepatic artery pseudoaneurysm secondary to collateral circulation formation after hepatic artery ligation in a patient with liver trauma. CASE PRESENTATION: A 52-year-old male patient was admitted to our hospital for liver trauma (Grade IV according to the American Association for the Surgery of Trauma (AAST) grading system) with active bleeding after a traffic accident. Hepatic artery ligation was performed for hemostasis. Three months after the surgery, the patient was readmitted for melena and subsequent hematemesis. Selective angiography examination revealed the formation of collateral circulation between the superior mesenteric artery and right hepatic artery. Moreover, a ruptured hepatic artery pseudoaneurysm was observed and transcatheter arterial embolization (TAE) was performed for hemostasis at the same time. After the treatment, the patient recovered very well and had an uneventful prognosis until the last follow-up. CONCLUSION: For patients with hepatic trauma, the selection of the site of hepatic artery ligation and the diagnosis and treatment methods of postoperative biliary hemorrhage are crucial for the prognosis of the disease.


Assuntos
Falso Aneurisma , Aneurisma Roto , Hemobilia , Artéria Hepática , Ligadura/efeitos adversos , Fígado , Traumatismos Abdominais/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Aneurisma Roto/etiologia , Aneurisma Roto/terapia , Angiografia/métodos , Ductos Biliares/diagnóstico por imagem , Ductos Biliares/lesões , Circulação Colateral , Embolização Terapêutica , Hematemese/etiologia , Hematemese/terapia , Hemobilia/etiologia , Hemobilia/terapia , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/lesões , Artéria Hepática/cirurgia , Humanos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Fígado/lesões , Masculino , Melena/etiologia , Melena/terapia , Pessoa de Meia-Idade , Recidiva , Circulação Esplâncnica
14.
Dig Dis ; 38(4): 348-351, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31830747

RESUMO

A hepatocellular carcinoma (HCC) rarely expands into the biliary tract. In this situation, because of its hypervascular nature, cholangitis or hemobilia may sometimes occur. Surgery is one of the options in this situation. However, patients with HCC and bile duct invasion are sometimes in a poor general condition, as in the case presented in this report. For such patients, surgical treatment may need to be invasive. Thus, here we report technical tips for triple covered metal stent deployment using side-by-side technique for hemobilia due to HCC. After guidewire deployments at the left, anterior, and posterior bile ducts, 6-mm covered self-expandable metal stents were placed at each bile duct. This may be useful for high-grade hepatic hilar obstruction due to HCC because drainage and hemostasis effects are obtained.


Assuntos
Carcinoma Hepatocelular/complicações , Hemobilia/etiologia , Hemobilia/cirurgia , Neoplasias Hepáticas/complicações , Stents Metálicos Autoexpansíveis , Idoso , Carcinoma Hepatocelular/diagnóstico por imagem , Colangiografia , Colestase/etiologia , Feminino , Hemobilia/diagnóstico por imagem , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
15.
BMC Surg ; 20(1): 307, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33261613

RESUMO

BACKGROUND: Hemobilia occurs mainly due to iatrogenic factors such as impairment of the right hepatic or cystic artery, and/or common bile duct in hepatobiliary-pancreatic surgery. However, little or no cases with hemobilia from the intra-pancreatic remnant bile duct after bile duct resection (BDR) has been reported. Here, we report a case of massive hemobilia due to the perforation of psuedoaneurysm of the gastroduodenal artery (GDA) to the intra-pancreatic remnant bile duct after hepatectomy with BDR. CASE PRESENTATION: A 68-year-old male underwent extended right hepatectomy with BDR for gallbladder carcinoma. He presented with upper gastrointestinal bleeding 2 months after the initial surgery. Upper endoscopy identified a blood clot from the ampulla of Vater and simultaneous endoscopic balloon tamponade contributed to temporary hemostasis. Abdominal CT and angiography revealed a perforation of the psuedoaneurysm of the GDA to the intra-pancreatic remnant bile duct resulting in massive hemobilia. Subsequent selective embolization of the pseudoaneurysm with micro-coils could achieve complete hemostasis. He survived without any recurrence of cancer and bleeding. CONCLUSION: Hemobilia could occur in a patient with BDR due to perforation of the pseudoaneurysm derived from the GDA to the intra-pancreatic remnant bile duct. Endoscopic balloon tamponade was useful for a temporal hemostasis and a subsequent radiologic interventional approach.


Assuntos
Falso Aneurisma , Ductos Biliares/cirurgia , Hemobilia , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Hemobilia/etiologia , Hemobilia/cirurgia , Artéria Hepática/patologia , Humanos , Masculino
16.
J Emerg Med ; 58(5): e227-e229, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32354592

RESUMO

BACKGROUND: Hemobilia refers to bleeding in the biliary tract, commonly due to iatrogenic, traumatic, and neoplastic causes. It is a rare source of upper gastrointestinal hemorrhage, but it can be severe and fatal. However, gallstones account for 5%-15% of hemobilia cases. CASE REPORT: A 60-year-old woman with diabetes mellitus and chronic kidney disease visited the emergency department with complaints of epigastric pain and vomiting of coffee ground-like content for 2 days. Physical examination revealed epigastric tenderness and hyperactive bowel sounds. Laboratory tests showed anemia with a hemoglobin count of 10.7 mg/dL and elevated liver function tests with total and direct bilirubin levels of 3.6 mg/dL and 2.5 mg/dL, respectively. Panendoscopy showed oozing of coffee ground-like material at the orifice of the ampulla of Vater and second portion of the duodenum, leading to suspicion of hemobilia. After admission, endoscopic retrograde cholangiopancreatography revealed common bile duct (CBD) dilatation with choledocholithiasis, biliary sludge, and filling defect at the middle section of the CBD. Endoscopic sphincterotomy with balloon lithotripsy was performed. After biliary decompression and broad-spectrum antibiotic administration, abdominal pain was relieved, and liver enzyme and total bilirubin levels improved. Symptoms of hemobilia depend on the bleeding rate and presence of bile duct obstructions due to clots. Minor and slow bleeding tend to form clots and cause biliary obstruction. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although minor hemobilia may remain asymptomatic and tends to resolve spontaneously, the cause of hemobilia must be corrected to prevent recurrent bleeding or obstruction.


Assuntos
Cálculos Biliares , Hemobilia , Dor Abdominal/etiologia , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Cálculos Biliares/complicações , Hemorragia Gastrointestinal/etiologia , Hemobilia/etiologia , Humanos , Pessoa de Meia-Idade
17.
Rev Esp Enferm Dig ; 112(3): 240, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32054281

RESUMO

We read with interest the article by Guido Villa-Gómez, Manuel Alejandro Mahler and Dante Manazzoni "A new case of pseudoaneurysm of the right hepatic artery secondary to laparoscopic cholecystectomy". A 57-year-old cholecystectomized female was admitted due to abdominal pain with an analytical pattern of cholestasis and liver enzyme alterations, with cholangitis that progressed to septic shock of a biliary origin with gradual anemia and hypotension.


Assuntos
Falso Aneurisma , Colangite , Colecistectomia Laparoscópica , Hemobilia , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico por imagem , Colangite/etiologia , Colangite/cirurgia , Feminino , Hemobilia/diagnóstico por imagem , Hemobilia/etiologia , Artéria Hepática/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade
18.
J Pak Med Assoc ; 70(5): 917-919, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32400753

RESUMO

Hepatic artery is the fourth most common site of the intraabdominal aneurysm, after infra renal aorta, iliac artery and splenic artery aneurysms. Rupture of the aneurysm may lead to the upper gastrointestinal haemorrhage. Here we report a 5 years old boy, who presented with fever, abdominal distension and unexplained upper GI bleed. Upper GI endoscopy revealed a normal esophagus and stomach with clear evidence of haemobilia with blood oozing from the ampulla. Fluoro- guided angiography followed by embolization of hepatic artery branches with 5 metallic coils was performed in this case by an interventional radiologist.


Assuntos
Aneurisma Roto , Aneurisma , Embolização Terapêutica/métodos , Endoscopia do Sistema Digestório/métodos , Hemorragia Gastrointestinal , Hemobilia , Artéria Hepática , Aneurisma/diagnóstico por imagem , Aneurisma Roto/diagnóstico , Aneurisma Roto/terapia , Angiografia/métodos , Pré-Escolar , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/fisiopatologia , Hemorragia Gastrointestinal/terapia , Hemobilia/diagnóstico , Hemobilia/etiologia , Hemobilia/fisiopatologia , Hemobilia/terapia , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/patologia , Humanos , Masculino , Resultado do Tratamento , Trato Gastrointestinal Superior/diagnóstico por imagem
19.
Liver Int ; 39(8): 1378-1388, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30932305

RESUMO

Hemobilia refers to macroscopic blood in the lumen of the biliary tree. It represents an uncommon, but important, cause of gastrointestinal bleeding and can have potentially lethal sequelae if not promptly recognized and treated. The earliest known reports of hemobilia date to the 17th century, but due to the relative rarity and challenges in diagnosis of hemobilia, it has historically not been well-studied. Until recently, most cases of hemobilia were due to trauma, but the majority now occur as a sequela of invasive procedures involving the hepatopancreatobiliary system. A triad (Quincke's) of right upper quadrant pain, jaundice and overt gastrointestinal bleeding has been classically described in hemobilia, but it is present in only a minority of patients. Therefore, prompt diagnosis depends critically on a high index of suspicion based on a patient's clinical presentation and a history of recently undergoing hepatopancreatobiliary intervention or having other predisposing factors. Treatment of hemobilia depends on the suspected source and clinical severity and thus ranges from supportive medical care to urgent advanced endoscopic, interventional radiologic, or surgical intervention. In the present review, we provide a historical perspective, clinical update and overview of current trends and practices pertaining to hemobilia.


Assuntos
Hemobilia/terapia , Colangiopancreatografia Retrógrada Endoscópica , Embolização Terapêutica , Hemobilia/diagnóstico por imagem , Hemobilia/epidemiologia , Hemobilia/etiologia , Humanos , Doença Iatrogênica , Tomografia Computadorizada por Raios X
20.
Vascular ; 26(4): 445-448, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29169300

RESUMO

Objectives Endovascular procedures are the treatment of choice in cases of intrahepatic fistulas. Arterio-biliary fistulas are the rarest and most difficult to treat, due to high risk of infection. Methods Eight cases of persistent hemobilia that developed as a result of arterio-biliary fistulas are presented. Five cases developed as a result of iatrogenic injury, two cases as a result of chronic infection, one case as a consequence of trauma. Results Patients were treated using endovascular embolization or combined endovascular and endoscopic biliary tract revision. The results were monitored after six to seven days and one month after embolization. The embolizations were considered effective in all cases. One patient had four asynchronous fistulas requiring separate treatments sessions. Four patients required a revision of their biliary ducts after embolization and restoration of patency. In one patient, a migration of the coil to biliary ducts occurred. Conclusion Endovascular treatment of arterio-biliary fistulas is safe and effective. The use of embolization with soft and biodegradable materials like histoacrylic glue or thrombin may be the optimal method of treatment in comparison with coils which have a risk of migration or chronic infection.


Assuntos
Fístula Biliar/terapia , Tomada de Decisão Clínica , Embolização Terapêutica , Procedimentos Endovasculares/métodos , Doença Iatrogênica , Seleção de Pacientes , Fístula Vascular/terapia , Adolescente , Adulto , Idoso , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/etiologia , Fístula Biliar/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar , Embolização Terapêutica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Hemobilia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Fístula Vascular/cirurgia
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