J Korean Soc Radiol.  2015 May;72(5):348-351. 10.3348/jksr.2015.72.5.348.

Massive Hemobilia due to Hepatic Arteriobiliary Fistula during Endoscopic Retrograde Cholangiopancreatography: An Extremely Rare Guidewire-Related Complication

• Nam JG
• Seo YW
• Hwang JC
• Weon YC
• Kang BS
• Bang SJ
• Bang MS

• KMID: 1793892
• DOI: http://doi.org/10.3348/jksr.2015.72.5.348

Abstract

Although endoscopic retrograde cholangiopancreatography (ERCP) is an effective modality for diagnosis and treatment of biliary and pancreatic diseases, the risk for procedure-related complications is high. Hemorrhage is one of major complications of ERCP. Most ERCP-associated bleeding is primarily a complication related to sphincterotomy rather than diagnostic ERCP. We are reporting a case of massive hemobilia due to hepatic arteriobiliary fistula caused by guidewire-associated injury during ERCP, which was successfully treated with transarterial embolization of the hepatic artery.

MeSH Terms

Cholangiopancreatography, Endoscopic Retrograde*
Diagnosis
Fistula*
Hemobilia*
Hemorrhage
Hepatic Artery
Pancreatic Diseases

Figure

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  Fig. 1 Selective hepatic arteriography showed an arteriobiliary fistula (arrow) with active contrast extravasation into the bile duct (arrowheads).

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  Fig. 2 Fluoroscopy following hepatic arteriography revealed irregular cast-like filling defects (arrows) in the bile duct due to massive hemobilia.

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  Fig. 3 Common hepatic arteriography after selective coil embolization showed coils (arrow) that were placed at the hepatic artery branch and no longer contrast extravasation.

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  Fig. 4 Coronal reformatted contrast-enhanced CT scan demonstrated no evidence of subcapsular hepatic hematoma or perihepatic free air, suggesting liver perforation.

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