Life-threatening hemorrhage from the papilla following stent removal (with video)

Abstract

A 73-year-old man was admitted with acute cholangitis due to stent occlusion. He had had type B chronic hepatitis for 14 years but no liver cirrhosis or coagulopathy. The stent was placed 2 months previously for the treatment of obstructive jaundice due to a very large hepatoma. Emergency endoscopic retrograde cholangiopancreatography was performed. Immediately after removing the stent, using snare forceps through the working channel of the endoscope, spurting and continuous bleeding was seen from the papilla. Biliary deep cannulation was successfully performed using a conventional catheter and guidewire. The tip of the catheter was advanced into the left intrahepatic bile duct for pressure hemostasis. Ten minutes later, the bleeding completely stopped and a 10-Fr stent was inserted into the bile duct.