Post written by Nao Fujimori, MD, PhD, from the Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Hemobilia is a rare but life-threatening adverse event related to pancreato-biliary diseases, transhepatic percutaneous, or endoscopic interventions. The rupture of the pseudoaneurysm after a plastic stent or self-expandable metallic stents (SEMSs) insertion or a plastic stent removal has been reported to induce massive hemobilia. However, hemobilia after SEMS removal is extremely rare. We here report a rare case of a patient with successful endoscopic tamponade using a fully covered SEMS for massive biliary bleeding from a pseudoaneurysm rupture during SEMS removal. A patient with advanced pancreatic head cancer was planned to exchange the SEMS due to stent occlusion. After an extraction of the SEMS using a snare through the scope, massive bleeding from the biliary tract was suddenly exacerbated, which resulted in a hemodynamic shock state within a few minutes. We promptly inserted a new SEMS for tamponade. The CT scan performed immediately after the endoscopic procedures revealed a 2-cm pseudoaneurysm in the pancreatic tumor, which was adjacent to the SEMS and was not evident on a CT 2 weeks ago. Subsequently, transcatheter arterial embolization was successfully performed for the pseudoaneurysm.

Removal of a SEMS is sometimes attempted in daily medical practice because of stent dysfunction. However, hemobilia can occur any time not only after the endoscopic insertion of plastic/metallic stents, but also during their extraction. Endoscopists must consider the rare possibility of massive hemobilia when attempting to remove SEMSs. During SEMS removal, it is necessary to have a new SEMS at hand.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.