RESUMEN
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.
Asunto(s)
Aneurisma Falso , Carcinoma Hepatocelular , Quimioembolización Terapéutica , Arteria Hepática , Neoplasias Hepáticas , Humanos , Aneurisma Falso/terapia , Aneurisma Falso/etiología , Masculino , Anciano , Quimioembolización Terapéutica/métodos , Quimioembolización Terapéutica/efectos adversos , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/terapia , Tomografía Computarizada por Rayos X , Procedimientos Endovasculares/métodos , Embolización Terapéutica/métodos , Resultado del Tratamiento , Hemobilia/etiología , Hemobilia/terapiaRESUMEN
INTRODUCTION: In median arcuate ligament syndrome (MALS), the celiac artery is compressed, causing an arcade to develop in the pancreatic head, leading to ischemic symptoms and aneurysms. PATIENT CONCERNS: The patient was diagnosed with borderline resectable pancreatic cancer (PC) and MALS. Endoscopic biliary drainage with a covered metal stent (CMS) was performed for the obstructive jaundice. After the jaundice improved, a modified FOLFIRINOX regimen was initiated. Several days later, cardiopulmonary arrest occurred after hematemesis occurred. Cardiopulmonary resuscitation was performed, his blood pressure stabilized, and emergent upper endoscopy was performed. The CMS was dislodged and active bleeding was observed in the papillae. The CMS was replaced, and temporary hemostasis was achieved. Contrast-enhanced computed tomography revealed a diagnosis of extravasation from the posterior superior pancreaticoduodenal artery (PSPDA) into the biliary tract. Transcatheter arterial embolization was performed. However, the patient was subsequently diagnosed with hypoxic encephalopathy and died on day 14 of hospitalization. DIAGNOSIS: Biliary hemorrhage due to invasion of pancreatic cancer from the PSPDA associated with MALS. INTERVENTION: None. OUTCOMES: Biliary hemorrhage from the PSPDA was fatal in the patient with invasive PC with MALS. LESSONS: Since MALS associated with PC is not a rare disease, the purpose of this study was to keep in mind the possibility of fatal biliary hemorrhage.
Asunto(s)
Hemobilia , Síndrome del Ligamento Arcuato Medio , Neoplasias Pancreáticas , Humanos , Protocolos de Quimioterapia Combinada Antineoplásica , Hemobilia/etiología , Hemorragia/complicaciones , Síndrome del Ligamento Arcuato Medio/diagnóstico , Neoplasias Pancreáticas/complicaciones , Neoplasias PancreáticasRESUMEN
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.
Asunto(s)
Aneurisma , Fístula Biliar , Hemobilia , Ictericia Obstructiva , Humanos , Fístula Biliar/diagnóstico , Fístula Biliar/etiología , Fístula Biliar/cirugía , Hemobilia/etiología , Hemobilia/complicaciones , Aneurisma/cirugía , Arteria Hepática/diagnóstico por imagen , Arteria Hepática/cirugía , Ictericia Obstructiva/diagnóstico , Ictericia Obstructiva/etiología , Ictericia Obstructiva/cirugíaRESUMEN
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.
Asunto(s)
Carcinoma Hepatocelular , Embolización Terapéutica , Hemobilia , Neoplasias Hepáticas , Masculino , Humanos , Anciano , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/patología , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/patología , Arteria Hepática/patología , Procedimientos Quirúrgicos Vasculares , Hemobilia/etiología , Hemobilia/terapiaAsunto(s)
Aneurisma Falso , Colecistectomía Laparoscópica , Embolización Terapéutica , Hemobilia , Humanos , Colecistectomía Laparoscópica/efectos adversos , Aneurisma Falso/etiología , Aneurisma Falso/complicaciones , Hemobilia/diagnóstico , Hemobilia/etiología , Vena Porta/diagnóstico por imagen , Arteria Hepática/diagnóstico por imagen , Embolización Terapéutica/efectos adversosAsunto(s)
Colecistectomía , Hemobilia , Humanos , Colecistectomía/efectos adversos , Hemobilia/etiologíaRESUMEN
Hemobilia is a rare condition defined as bleeding in the biliary tract. The clinical presentation is variable. The typical manifestation consists of jaundice, upper gastrointestinal bleeding, and right upper quadrant abdominal pain. This set of symptoms is known as "Quincke's triad." It is present in only 22%-35% of cases. Post-traumatic hemobilia is an extraordinarily rare condition occurring in only 6% of the patients with hemobilia. In general, it occurs in less than 0.2% of patients with liver trauma. A delay in the development of bleeding after liver trauma is frequent. Early diagnosis is essential because massive bleeding into the biliary tract is a potentially life-threatening condition. We present a case of a patient with massive hemobilia developed 12 days after blunt abdominal trauma. Computed tomography angiography showed two pseudoaneurysms in hepatic segments V and VIII with contrast medium extravasation. We successfully performed digital subtraction angiography with selective transcatheter arterial embolization of the leaking segment VIII pseudoaneurysm. Embolization of the pseudoaneurysm in segment V was technically impracticable. Our article provides a review of the published literature focussing on the prevalence, diagnostics, and treatment of post-traumatic hemobilia.
Asunto(s)
Aneurisma Falso , Hemobilia , Ictericia , Heridas no Penetrantes , Humanos , Hemobilia/etiología , Hemobilia/diagnóstico , Hemobilia/terapia , Hígado/lesiones , Ictericia/etiología , Hemorragia Gastrointestinal , Heridas no Penetrantes/complicacionesRESUMEN
Objective Pseudoaneurysm rupture associated with unresected pancreatic cancer can cause rare but fatal hemobilia and gastrointestinal bleeding. This study aimed to identify factors predicting pseudoaneurysm rupture. Methods We conducted a single-center case-control study of unresected pancreatic cancer patients treated at Shizuoka General Hospital between January 2011 and July 2020 using a retrospective cancer registry database. Included in the study were 611 consecutive patients with unresected pancreatic cancer, of whom 55 developed overt upper gastrointestinal bleeding or hemobilia. Twenty patients were excluded, as they had not undergone contrast-enhanced computed tomography (CT) or angiography. Patients were classified into pseudoaneurysm and non-pseudoaneurysm groups. One patient with arterial bleeding but without obvious pseudoaneurysm was included in the pseudoaneurysm group. Factors predicting pseudoaneurysm rupture at the onset of overt gastrointestinal bleeding were investigated using a logistic regression analysis. CT findings revealing air bubbles inside the tumor were described as intratumoral air bubbles. Results Thirty-five patients were included (15 in the pseudoaneurysm group, 20 in the non-pseudoaneurysm group). In the multivariate analysis, intratumoral air bubbles [odds ratio (OR), 12.9; 95% confidence interval (CI), 2.14-77.9; p=0.005] and hematemesis (OR, 6.30; 95% CI, 1.03-38.6; p=0.047) were independent predictors of pseudoaneurysm rupture. In addition, patients who experienced successful hemostasis and were re-administered chemotherapy survived more than six months. Conclusion This study reveals that intratumoral air bubbles and hematemesis may predict pseudoaneurysm rupture at the onset of overt gastrointestinal bleeding. For patients presenting these findings, an examination with conventional or CT angiography may lead to an early diagnosis and improve the patient prognosis.
Asunto(s)
Aneurisma Falso , Hemobilia , Neoplasias Pancreáticas , Humanos , Hematemesis/etiología , Hemobilia/etiología , Estudios de Casos y Controles , Estudios Retrospectivos , Aneurisma Falso/complicaciones , Aneurisma Falso/diagnóstico por imagen , Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/epidemiología , Hemorragia Gastrointestinal/etiología , Neoplasias Pancreáticas/complicacionesRESUMEN
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.
Asunto(s)
Aneurisma Falso , Embolización Terapéutica , Hemobilia , Neoplasias Pancreáticas , Anciano , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/terapia , Autopsia , Quimioradioterapia/efectos adversos , Embolización Terapéutica/efectos adversos , Hemobilia/etiología , Humanos , Masculino , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/terapia , Neoplasias PancreáticasRESUMEN
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.
Asunto(s)
Aneurisma Falso , Colestasis , Embolización Terapéutica , Hemobilia , Humanos , Hemobilia/diagnóstico por imagen , Hemobilia/etiología , Hemobilia/terapia , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/terapia , Arteria Hepática , Stents/efectos adversos , Embolización Terapéutica/métodos , Colestasis/complicacionesRESUMEN
Hemobilia is an extremely rare cause of upper gastrointestinal bleeding. It often has intermittent manifestation, which may lead to significant diagnostic delay. In 65% of the cases, the causes are iatrogenic, in 7% the cause is malignancy, in 5% - gallstones, in 8% it is inflammation (cholecystitis, parasites, reflux cholangitis), vascular abnormality is the cause in 7% (most commonly pseudoaneurysm of the hepatic artery), and pancreatic pseudocyst causes hemobilia in 1%. In almost all cases, the bleeding originates from intrahepatic or extrahepatic bile ducts, and rarely from the pancreas.
Asunto(s)
Fístula , Hemobilia , Conducto Colédoco , Diagnóstico Tardío/efectos adversos , Fístula/complicaciones , Fístula/diagnóstico , Fístula/patología , Hemobilia/diagnóstico , Hemobilia/etiología , Hemobilia/terapia , Arteria Hepática/diagnóstico por imagen , Arteria Hepática/patología , Arteria Hepática/cirugía , HumanosRESUMEN
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.
Asunto(s)
Fístula Biliar , Colestasis , Hemobilia , Trasplante de Hígado , Fístula Biliar/diagnóstico por imagen , Fístula Biliar/etiología , Fístula Biliar/cirugía , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colestasis/complicaciones , Femenino , Hemobilia/diagnóstico por imagen , Hemobilia/etiología , Hemobilia/terapia , Humanos , Trasplante de Hígado/efectos adversos , Persona de Mediana Edad , Stents/efectos adversosAsunto(s)
Fístula Biliar , Embolización Terapéutica , Hemobilia , Fístula Biliar/diagnóstico por imagen , Fístula Biliar/etiología , Fístula Biliar/cirugía , Embolización Terapéutica/efectos adversos , Hemobilia/complicaciones , Hemobilia/etiología , Arteria Hepática/diagnóstico por imagen , HumanosRESUMEN
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.
Asunto(s)
Cateterismo , Cálculos Renales , Cateterismo/efectos adversos , Cateterismo/métodos , Dilatación/métodos , Hemobilia/etiología , Humanos , Cálculos Renales/terapia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
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.
Asunto(s)
Embolización Terapéutica/métodos , Enbucrilato/administración & dosificación , Hemobilia/terapia , Adulto , Anciano , Anciano de 80 o más Años , Angiografía , Catéteres , Embolización Terapéutica/efectos adversos , Enbucrilato/efectos adversos , Aceite Etiodizado/administración & dosificación , Femenino , Hemobilia/diagnóstico por imagen , Hemobilia/etiología , Arteria Hepática/diagnóstico por imagen , Arteria Hepática/lesiones , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Stents , Resultado del TratamientoRESUMEN
Hemobilia which is firstly described in 1948 is a rare cause of gastrointestinal bleeding. Since its main clinic takes time to occur and may cause mortality, early diagnosis and management have a great importance. Almost for 3 years, the world has been facing with an unknown viral infection called COVID-19 whose clinic changes from asymptomatic respiratory infection to symptoms associated with multiple system involvement. The clinical presentation of Covid-19 infection varies tremendously depending on the severity of the illness. In this report, we present the first two cases of severe COVID-19 induced hemobilia.
Asunto(s)
COVID-19/complicaciones , Hemorragia Gastrointestinal/etiología , Hemobilia/etiología , Hemorragia Gastrointestinal/diagnóstico , Hemobilia/diagnóstico , Humanos , SARS-CoV-2RESUMEN
Gallbladder cancer that presents as acute cholecystitis associated with hemocholecyst and hemobilia is a rare entity. There are few cases reported in the literature. We present a case of gallbladder carcinoma diagnosed after emergency cholecystectomy, performed due to hemobilia and acute cholecystitis due to hemocholecyst.
El cáncer de vesícula biliar que se presenta como una colecistitis aguda asociada a hemocolecisto y hemobilia es muy infrecuente. Hasta la fecha hay pocos casos informados en la literatura. Presentamos un caso de carcinoma de vesícula biliar diagnosticado tras colecistectomía de urgencia, realizada por hemobilia y colecistitis aguda por hemocolecisto.
Asunto(s)
Colecistitis Aguda , Enfermedades de la Vesícula Biliar , Neoplasias de la Vesícula Biliar , Hemobilia , Colecistectomía , Colecistitis Aguda/complicaciones , Enfermedades de la Vesícula Biliar/complicaciones , Enfermedades de la Vesícula Biliar/diagnóstico por imagen , Neoplasias de la Vesícula Biliar/complicaciones , Neoplasias de la Vesícula Biliar/diagnóstico por imagen , Neoplasias de la Vesícula Biliar/cirugía , Hemobilia/etiología , Hemobilia/cirugía , HumanosRESUMEN
A rare case of arterio-biliary fistula and haemobilia complicating intra-operative microwave ablation of hepatocellular carcinoma in a 58-year-old woman with cirrhosis.