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KMID : 0985520230280030081
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Korean Journal of Pancreas and Biliary Tract
2023 Volume.28 No. 3 p.81 ~ p.88
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Two Cases of Life-Threatening Hemobilia Following Removal of Biliary Stents Treated with Covered Self-Expandable Metal Stents
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Woo Ji- Hun
Kim Jun-Yeol
Choi Jin-Ho
Kang Joon-Gyu
Paik Woo-Hyun
Ryu Ji-Kon
Kim Yong-Tae
Lee Sang-Hyub
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Abstract
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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, same-session covered self-expandable metal stent (CSEMS) insertion may be useful as a rescue or bridge therapy before angiography. Here, we report two cases of life-threatening 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.
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KEYWORD
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Hemobilia, Biliary stent, Covered self-expandable metal stent, Angiography, Pseudoaneurysm
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