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Case Reports
. 2020 Feb 28;2020(2):omaa010.
doi: 10.1093/omcr/omaa010. eCollection 2020 Feb.

Haemobilia in a previously stented hilar cholangiocarcinoma: successful haemostasis after the insertion of fcSEMS

T Tien  1 , Y C Tan  1 , P Baptiste  2 , S Tanwar  1
Affiliations
Case Reports

Haemobilia in a previously stented hilar cholangiocarcinoma: successful haemostasis after the insertion of fcSEMS

T Tien et al. Oxf Med Case Reports. .

Abstract

Haemobilia describes blood loss from the biliary tract and classically presents as Quincke's triad: upper gastrointestinal bleeding (UGIB), jaundice and right upper quadrant abdominal pain. We discuss the case of a 70-year-old male with a previously stented Bismuth 1 hilar cholangiocarcinoma who presented with haematemesis. He had a similar presentation a month ago where a forward viewing gastroscope identified fresh and altered blood in the distal stomach but no clear source of bleeding. During this admission, a side-viewing duodenoscope identified bleeding from the periampullary region, which was managed by inserting a fully covered self-expanding metal stent (fcSEMS) within his pre-existing uncovered SEMS to tamponade the haemorrhage. This case highlights the importance of using a side-viewing duodenoscope for patients with UGIB on a background of a stented cholangiocarcinoma and inserting a fcSEMS within an uncovered SEMS is feasible and effective in managing these patients.

Keywords: SEMS; cholangiocarcinoma; haemobilia.

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Figures

Figure 1
Figure 1
(A) Perihilar stricture identified at index ERCP due to cholangiocarcinoma; (B) Uncovered SEMS inserted across the perihilar stricture to decompress the biliary tree.
Figure 2
Figure 2
(A) ERCP image taken at the time of presentation with haemobilia identifying a single uncovered SEMS in situ; (B) ERCP image during fcSEMS deployment within the uncovered SEMS; (C) Subsequent abdominal radiograph showing both uncovered SEMS and fcSEMS in place.
See this image and copyright information in PMC

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