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. 2019 Feb 26;4(4):163-165.
doi: 10.1016/j.vgie.2018.12.004. eCollection 2019 Apr.

EUS-guided thrombin injection of cystic artery pseudoaneurysm leading to Mirizzi's syndrome and hemobilia

Malay Sharma  1 , Piyush Somani  2 , Rahul Talele  1 , Vikas Kohli  1 , Tagore Sunkara  3
Affiliations

EUS-guided thrombin injection of cystic artery pseudoaneurysm leading to Mirizzi's syndrome and hemobilia

Malay Sharma et al. VideoGIE. .
No abstract available

Keywords: CBD, common bile duct; CHD, common hepatic duct.

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Figures

Figure 1
Figure 1
Abdominal US view showing pseudoaneurysm, 3.4 cm × 2.4 cm, arising from cystic artery.
Figure 2
Figure 2
CT angiographic view showing pseudoaneurysm of cystic artery. RHA, Right hepatic artery; LHA, left hepatic artery; HAP, hepatic artery proper; CHA, common hepatic artery; GDA, gastroduodenal artery.
Figure 3
Figure 3
Linear EUS from duodenal bulb showing pseudoaneurysm. CBD, Common bile duct.
Figure 4
Figure 4
A stone 1 cm in diameter was seen near the neck of the gallbladder. The wall thickness of the aneurysm was 6 mm, and its internal diameter of the aneurysm was 1.5 cm.
Figure 5
Figure 5
A branch of the hepatic artery seen proceeding toward the neck of the pseudoaneurysm.
Figure 6
Figure 6
Injection of 500 units of human thrombin into the aneurysm with a 22-gauge needle.
Figure 7
Figure 7
ERCP image showing blood clots coming out from papilla, suggestive of hemobilia.
Figure 8
Figure 8
Cholangiogram showing narrowing of CHD. The length of the narrowing was about 3 cm. CHD, Common hepatic duct.
Figure 9
Figure 9
On dissection of the neck of the gallbladder, the thrombosed part of the aneurysm was initially delivered. Subsequently a stone present in neck area was removed.
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