Hemostasis using a covered self‐expandable metal stent for pseudoaneurysm bleeding from the perihilar bile duct

Abstract Although there are many reports of hemostasis with covered self‐expandable metal stent (CSEMS) for bleeding from the papilla of Vater and the intrapapillary and distal bile duct, there are rare reports of its use for hemostasis in the perihilar bile duct. We report the case of a patient und...

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Main Authors: Yu Ishii, Akihiro Nakayama, Kazuo Kikuchi, Kei Nakatani, Kenichi Konda, Daichi Mori, Shigetoshi Nishihara, Shu Oikawa, Tomohiro Nomoto, Tomono Usami, Toshihiro Noguchi, Yuta Mitsui, Hitoshi Yoshida
Format: Article
Language:English
Published: Wiley 2023-04-01
Series:DEN Open
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Online Access:https://doi.org/10.1002/deo2.150
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author Yu Ishii
Akihiro Nakayama
Kazuo Kikuchi
Kei Nakatani
Kenichi Konda
Daichi Mori
Shigetoshi Nishihara
Shu Oikawa
Tomohiro Nomoto
Tomono Usami
Toshihiro Noguchi
Yuta Mitsui
Hitoshi Yoshida
author_facet Yu Ishii
Akihiro Nakayama
Kazuo Kikuchi
Kei Nakatani
Kenichi Konda
Daichi Mori
Shigetoshi Nishihara
Shu Oikawa
Tomohiro Nomoto
Tomono Usami
Toshihiro Noguchi
Yuta Mitsui
Hitoshi Yoshida
author_sort Yu Ishii
collection DOAJ
description Abstract Although there are many reports of hemostasis with covered self‐expandable metal stent (CSEMS) for bleeding from the papilla of Vater and the intrapapillary and distal bile duct, there are rare reports of its use for hemostasis in the perihilar bile duct. We report the case of a patient undergoing supportive care for perihilar cholangiocarcinoma with acute cholecystitis after side‐by‐side placement of uncovered SEMS for perihilar bile duct obstruction. Percutaneous transhepatic gallbladder aspiration was performed upon admission, and hematemesis occurred the next day. Since computed tomography scanning showed a pseudoaneurysm in the right uncovered SEMS, hemostasis by interventional radiology (IVR) was performed thrice for massive bleeding; however, hemostasis could not be achieved. When endoscopic retrograde cholangiopancreatography was performed for scrutiny and treatment of melena and increased hepatobiliary enzyme, the endoscopic visual field could not be secured by bleeding, and changes in hemodynamics were observed; thus, IVR was required, but it was difficult to perform. Since bleeding from the right bile duct was expected, hemostasis was performed using CSEMS. This is the first report of hemostasis performed by placing a covered SEMS for bleeding from a pseudoaneurysm of the intrahepatic bile duct.
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spelling doaj-art-bf3fc218fbce4b12a06a94c475f3d9f22025-08-20T03:10:01ZengWileyDEN Open2692-46092023-04-0131n/an/a10.1002/deo2.150Hemostasis using a covered self‐expandable metal stent for pseudoaneurysm bleeding from the perihilar bile ductYu Ishii0Akihiro Nakayama1Kazuo Kikuchi2Kei Nakatani3Kenichi Konda4Daichi Mori5Shigetoshi Nishihara6Shu Oikawa7Tomohiro Nomoto8Tomono Usami9Toshihiro Noguchi10Yuta Mitsui11Hitoshi Yoshida12Department of Medicine, Division of Gastroenterology Showa University School of Medicine Tokyo JapanDepartment of Medicine, Division of Gastroenterology Showa University School of Medicine Tokyo JapanDepartment of Medicine, Division of Gastroenterology Showa University School of Medicine Tokyo JapanDepartment of Medicine, Division of Gastroenterology Showa University School of Medicine Tokyo JapanDepartment of Medicine, Division of Gastroenterology Showa University School of Medicine Tokyo JapanDepartment of Medicine, Division of Gastroenterology Showa University School of Medicine Tokyo JapanDepartment of Medicine, Division of Gastroenterology Showa University School of Medicine Tokyo JapanDepartment of Medicine, Division of Gastroenterology Showa University School of Medicine Tokyo JapanKawasaki Kyodo Hospital Kanagawa JapanDepartment of Medicine, Division of Gastroenterology Showa University School of Medicine Tokyo JapanDepartment of Medicine, Division of Gastroenterology Showa University School of Medicine Tokyo JapanDepartment of Medicine, Division of Gastroenterology Showa University School of Medicine Tokyo JapanDepartment of Medicine, Division of Gastroenterology Showa University School of Medicine Tokyo JapanAbstract Although there are many reports of hemostasis with covered self‐expandable metal stent (CSEMS) for bleeding from the papilla of Vater and the intrapapillary and distal bile duct, there are rare reports of its use for hemostasis in the perihilar bile duct. We report the case of a patient undergoing supportive care for perihilar cholangiocarcinoma with acute cholecystitis after side‐by‐side placement of uncovered SEMS for perihilar bile duct obstruction. Percutaneous transhepatic gallbladder aspiration was performed upon admission, and hematemesis occurred the next day. Since computed tomography scanning showed a pseudoaneurysm in the right uncovered SEMS, hemostasis by interventional radiology (IVR) was performed thrice for massive bleeding; however, hemostasis could not be achieved. When endoscopic retrograde cholangiopancreatography was performed for scrutiny and treatment of melena and increased hepatobiliary enzyme, the endoscopic visual field could not be secured by bleeding, and changes in hemodynamics were observed; thus, IVR was required, but it was difficult to perform. Since bleeding from the right bile duct was expected, hemostasis was performed using CSEMS. This is the first report of hemostasis performed by placing a covered SEMS for bleeding from a pseudoaneurysm of the intrahepatic bile duct.https://doi.org/10.1002/deo2.150endoscopic retrograde cholangiopancreatographyhemobiliainterventional radiologymetal stentpseudoaneurysm
spellingShingle Yu Ishii
Akihiro Nakayama
Kazuo Kikuchi
Kei Nakatani
Kenichi Konda
Daichi Mori
Shigetoshi Nishihara
Shu Oikawa
Tomohiro Nomoto
Tomono Usami
Toshihiro Noguchi
Yuta Mitsui
Hitoshi Yoshida
Hemostasis using a covered self‐expandable metal stent for pseudoaneurysm bleeding from the perihilar bile duct
DEN Open
endoscopic retrograde cholangiopancreatography
hemobilia
interventional radiology
metal stent
pseudoaneurysm
title Hemostasis using a covered self‐expandable metal stent for pseudoaneurysm bleeding from the perihilar bile duct
title_full Hemostasis using a covered self‐expandable metal stent for pseudoaneurysm bleeding from the perihilar bile duct
title_fullStr Hemostasis using a covered self‐expandable metal stent for pseudoaneurysm bleeding from the perihilar bile duct
title_full_unstemmed Hemostasis using a covered self‐expandable metal stent for pseudoaneurysm bleeding from the perihilar bile duct
title_short Hemostasis using a covered self‐expandable metal stent for pseudoaneurysm bleeding from the perihilar bile duct
title_sort hemostasis using a covered self expandable metal stent for pseudoaneurysm bleeding from the perihilar bile duct
topic endoscopic retrograde cholangiopancreatography
hemobilia
interventional radiology
metal stent
pseudoaneurysm
url https://doi.org/10.1002/deo2.150
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