Management of Hemodynamic Collapse After Liver Transplantation From Native Bile Duct Stump Hemorrhage with Gelfoam

Abstract

Spontaneous hemobilia is a rare complication after liver transplantation and is largely secondary to the formation of an arteriobiliary fistula, which is generally treated by vascular interventional radiology embolization. We present a case of hemorrhagic shock secondary to arterial hemorrhage at an oversewn bile duct stump after liver transplantation, which failed vascular interventional radiology embolization, and was subsequently controlled using an endoscopic application of a gelatin sponge slurry (Gelfoam). We present this unique approach and review the history of this surgical and interventional hemostasis tool that has not been previously described for endoscopic use.

Figure 1.

Duodenoscopic examination showing hemobilia.

Figure 2.

Endoscopic contrast injected into the blind bile duct stump.

Figure 3.

Arteriogram showing (A) mesenteric vasculature and (B) persistent bleeding from a branch of the pancreaticoduodenal artery.

Figure 4.

Gelfoam setup showing syringes connected by a (A) 3-way valve, (B) intact Gelfoam, and (C) prepared Gelfoam cut for endoscopically deliverable slurry.