Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2010 Jul 14:10:81.
doi: 10.1186/1471-230X-10-81.

Life-threatening hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy: report of a case

Yueh-Tsung Lee  1 , Ho Lin, Kuan-Yung Chen, Hurng-Sheng Wu, Min-Ho Hwang, Sheng-Lei Yan
Affiliations
Case Reports

Life-threatening hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy: report of a case

Yueh-Tsung Lee et al. BMC Gastroenterol. .

Abstract

Background: Hemobilia is a rare but lethal biliary tract complication. There are several causes of hemobilia which might be classified as traumatic or nontraumatic. Hemobilia caused by pseudoaneurysm might result from hepatobiliary surgery or percutaneous interventional hepatobiliary procedures. However, to our knowledge, there are no previous reports pertaining to hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy.

Case presentation: A 65-year-old male was admitted to our hospital because of acute calculous cholecystitis and cholangitis. He underwent cholecystectomy, choledocholithotomy via a right upper quadrant laparotomy and a temporary T-tube choledochostomy was created. However, on the 19th day after operation, he suffered from sudden onset of hematemesis and massive fresh blood drainage from the T-tube choledochostomy. Imaging studies confirmed the diagnosis of pseudoaneurysm associated hemobilia. The probable association of T-tube choledochostomy with pseudoaneurysm and hemobilia is also demonstrated. He underwent emergent selective microcoils emobolization to occlude the feeding artery of the pseudoaneurysm.

Conclusions: Pseudoaneurysm associated hemobilia may occur after T-tube choledochostomy. This case also highlights the importance that hemobilia should be highly suspected in a patient presenting with jaundice, right upper quadrant abdominal pain and upper gastrointestinal bleeding after liver or biliary surgery.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Contrasted enhanced CT of the abdomen was arranged showing a round and hyperdense lesion (long arrow) abutting the T-tube choledochostomy (short arrow).
Figure 2
Figure 2
Reconstructive CT image showing a saccular mass protruding from the proper hepatic artery.
Figure 3
Figure 3
Transarterial angiographic view showing a contrast-filled lesion arising from proper hepatic artery. Adjacent to the contrast-filled lesion was the T-tube (arrow).
Figure 4
Figure 4
Transarterial angiographic view showing that contrast drained into the T-tube choledochostomy (arrow).
Figure 5
Figure 5
Transarterial angiographic view showing that the pseudoaneurym was occluded using selective microcoils emobolization.
See this image and copyright information in PMC

References

    1. Sandblom P. Hemorrhage into the biliary tract following trauma; traumatic hemobilia. Surgery. 1948;24:571–586. - PubMed
    1. Green MH, Duell RM, Johnson CD, Jamieson NV. Haemobilia. Br J Surg. 2001;88:773–786. doi: 10.1046/j.1365-2168.2001.01756.x. - DOI - PubMed
    1. Lygidakis NJ, Okazaki M, Damtsios G. Iatrogenic hemobilia: how to approach it. Hepatogastroenterology. 1991;38:454–457. - PubMed
    1. Curet P, Baumer R, Roche A, Grellet J, Mercadier M. Hepatic hemobilia of traumatic or iatrogenic origin: recent advances in diagnosis and therapy, review of the literature from 1976 to 1981. World J Surg. 1984;8:2–8. doi: 10.1007/BF01658356. - DOI - PubMed
    1. de Perrot M, Berney T, Buhler L, Delgadillo X, Mentha G, Morel P. Management of bleeding pseudoaneurysms in patients with pancreatitis. Br J Surg. 1999;86:29–32. doi: 10.1046/j.1365-2168.1999.00983.x. - DOI - PubMed

Publication types

LinkOut - more resources