Delayed post sphincterotomy bleeding: Hemostatic powder is a safe and effective option.
Rev Esp Enferm Dig
; 2024 Jan 11.
Article
in En
| MEDLINE
| ID: mdl-38205710
ABSTRACT
We present the case of a 72-year-old woman admitted for epigastric pain, elevated inflammatory parameters and liver enzymes, with a total bilirubin of 6mg/dL. Abdominal ultrasound identified cholelithiasis and posteriorly endoscopic ultrasound showed a 5.8mm stone distally in the biliary tract. Due to acute cholangitis, she underwent endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy, successfully removing the stone. Mild self-limited bleeding after sphincterotomy was reported, for which an adrenaline flush of the biliary tract was performed. The following day, she presented melena and hemoglobin dropped 3g/dL, remaining hemodynamically stable. With side-viewing duodenoscopy we identified an adherent clot and an oozing bleed near the pancreatic duct opening. The clot was removed with a snare after adrenalin injection and 3 endoclips of 8mm were positioned in the superior portion of the sphincterotomy. Even then, bleeding persisted. We opted to apply hemostatic powder (Hemospray®) with successful bleeding cessation. Four days later the patient was released without bleeding recurrence or suspected biliary blockage.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Language:
En
Journal:
Rev Esp Enferm Dig
Journal subject:
GASTROENTEROLOGIA
Year:
2024
Type:
Article
Affiliation country:
Portugal