Yeungnam Univ J Med.  2018 Jun;35(1):109-113. 10.12701/yujm.2018.35.1.109.

Coil embolization of ruptured intrahepatic pseudoaneurysm through percutaneous transhepatic biliary drainage

Affiliations
  • 1Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 2Department of Internal Medicine, Changwon Fatima Hospital, Changwon, Korea. 4796pjhsms@naver.com

Abstract

A 75-year-old man with chronic cholangitis and a common bile duct stone that was not previously identified was admitted for right upper quadrant pain. Acute cholecystitis with cholangitis was suspected on abdominal computed tomography (CT); therefore, endoscopic retrograde cholangiopancreatography with endonasal biliary drainage was performed. On admission day 5, hemobilia with rupture of two intrahepatic artery pseudoaneurysms was observed on follow-up abdominal CT. Coil embolization of the pseudoaneurysms was conducted using percutaneous transhepatic biliary drainage. After several days, intrahepatic artery pseudoaneurysm rupture recurred and coil embolization through a percutaneous transhepatic biliary drainage tract was conducted after failure of embolization via the hepatic artery due to previous coiling. After the second coil embolization, a common bile duct stone was removed, and the patient presented no complications during 4 months of follow-up. We report a case of intrahepatic artery pseudoaneurysm rupture without prior history of intervention involving the hepatobiliary system that was successfully managed using coil embolization through percutaneous transhepatic biliary drainage.

Keyword

Hepatic artery; Pseudoaneurysm; Hemobilia; Embolization

MeSH Terms

Aged
Aneurysm, False*
Arteries
Cholangiopancreatography, Endoscopic Retrograde
Cholangitis
Cholecystitis, Acute
Common Bile Duct
Drainage*
Embolization, Therapeutic*
Follow-Up Studies
Hemobilia
Hepatic Artery
Humans
Rupture
Tomography, X-Ray Computed

Figure

  • Fig. 1. Initial abdominal computed tomography. (A) High density materials are seen in gallbladder and common bile duct with marked biliary dilatation and pericholecystic infiltrations suggesting intramural gallbladder hematoma and cholangitis. (B) Suspcious intrahepatic aneurysms (arrows) are seen at liver segment 5 and hemobilia induced biliary dilatations are observed.

  • Fig. 2. Follow-up abdominal computed tomography. (A) Two intrahepatic psuedoaneurysms (arrows) with partial rupture and active bleeding at liver segment 5 is observed with intrabiliary hematoma and biliary dilatation (arrow heads). (B) Intrahepatic bile duct dilatation (arrow head) and right perihepatic subcapsular hematoma (arrow) at liver dome due to rupture and spillage of intrahepatic bile duct are observed.

  • Fig. 3. Initial hepatic artery angiography. (A) Two intrahepatic pseudoaneurysms (arrows) at liver segment 5 are seen. (B) Inserted coils (arrow) for embolization of the intrahepatic pseudoaneurysm are observed.

  • Fig. 4. Follow-up hepatic artery angiography. (A) Recurred intrahepatic pseudoaneurysm (arrow) is observed at liver segment 5. (B) After approach of the intrahepatic bile duct — intrahepatic pseudoaneursym fistula using microcatheter through a percutaneous transhepatic biliary drainage tract, the psuedoaneurysm (arrow) and intrahepatic artery (arrow head) are seen. (C) Inserted coils (arrow) for embolization of recurred intrahepatic pseudoaneurysm are observed.


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