Pseudoaneurysms of the cystic artery and cholecystoduodenal fistula formation are rare complications of cholecystitis and either may result from an inflammatory process in the abdomen. A 68-year-old man admitted with acute cholecystitis subsequently developed massive upper gastrointestinal (GI) bleeding. Abdominal computed tomography showed acute calculous cholecystitis and hemobilia secondary to bleeding from the cystic artery. Angiography suggested a ruptured pseudoaneurysm of the cystic artery. Upper GI endoscopy showed a deep active ulcer with an opening that was suspected to be that of a fistula at the duodenal bulb. The patient was managed successfully with multimodality treatment that included embolization followed by elective laparoscopic cholecystectomy. Presently, there is no clear consensus regarding the clinical management of this disease. We have been able to confirm various clinical features, diagnoses, and treatments of this disease through a literature review. A multidisciplinary approach through interagency/interdepartmental collaboration is necessary for better management of this disease.
Abdomen ; Aged ; Aneurysm, False ; Angiography ; Arteries ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Consensus ; Cooperative Behavior ; Diagnosis ; Endoscopy ; Fistula ; Hemobilia ; Hemorrhage ; Humans ; Intestinal Fistula ; Ulcer

SUMMARY OF EVENT: Melena with abdominal pain were developed in a patient who had undergone endoscopic retrograde cholangiopancreatography (ERCP) with common bile duct stones removal and endoscopic retrograde biliary drainage (ERBD) using a plastic biliary stent. He subsequently underwent laparoscopic cholecystectomy. For the diagnosis and treatment of hemobilia caused by a plastic biliary stent, selective angiography for gastroduodenal artery with subsequent embolization for small pseudoaneurysm of pancreaticoduodenal artery was done successfully. TEACHING POINT: A plastic biliary stent induced pseudoaneurysm can be a cause of hemobilia after ERCP with ERBD procedure. Selective angiography with embolization for bleeding pseudoaneurysm can be an effective treatment for this situation.
Abdominal Pain ; Aneurysm, False ; Angiography ; Arteries* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Common Bile Duct ; Diagnosis ; Drainage ; Hemobilia* ; Hemorrhage ; Humans ; Melena ; Plastics* ; Stents*

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential method for diagnosis and treatment of various pancreatobiliary diseases and endoscopic sphincterotomy (EST) is the gateway to complete ERCP. Although techniques and instruments for EST have improved, bleeding is still the most common complication. Treatment of immediate post-EST bleeding is important because blood can interfere with subsequent procedures. Additionally, endoscopists should be cautious about delayed bleeding may cause hemobilia, cholangitis, and hemodynamic shock. Most cases of post-EST bleedings will stop spontaneously, however, endoscopic management is necessary in case of clinically significant and persistent bleeding. Various endoscopic methods including epinephrine or fibrin glue injection, electrocoagulation, hemoclipping and band ligation et al can be used through a sideviewing or forward-viewing endoscope similar to those used in hemostasis of peptic ulcer bleeding. Endoscopists who perform ERCP should use various methods of endoscopic hemostasis strategically.
Arm* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Diagnosis ; Electrocoagulation ; Endoscopes ; Epinephrine ; Fibrin Tissue Adhesive ; Hemobilia ; Hemodynamics ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Ligation ; Methods ; Peptic Ulcer ; Shock ; Sphincterotomy, Endoscopic

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential method for diagnosis and treatment of various pancreatobiliary diseases and endoscopic sphincterotomy (EST) is the gateway to complete ERCP. Although techniques and instruments for EST have improved, bleeding is still the most common complication. Treatment of immediate post-EST bleeding is important because blood can interfere with subsequent procedures. Additionally, endoscopists should be cautious about delayed bleeding may cause hemobilia, cholangitis, and hemodynamic shock. Most cases of post-EST bleedings will stop spontaneously, however, endoscopic management is necessary in case of clinically significant and persistent bleeding. Various endoscopic methods including epinephrine or fibrin glue injection, electrocoagulation, hemoclipping and band ligation et al can be used through a sideviewing or forward-viewing endoscope similar to those used in hemostasis of peptic ulcer bleeding. Endoscopists who perform ERCP should use various methods of endoscopic hemostasis strategically.
Arm* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Diagnosis ; Electrocoagulation ; Endoscopes ; Epinephrine ; Fibrin Tissue Adhesive ; Hemobilia ; Hemodynamics ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Ligation ; Methods ; Peptic Ulcer ; Shock ; Sphincterotomy, Endoscopic

Gastrointestinal bleeding from the biliary tree, called hemobilia, is an uncommon event. It may clinically present as hematemesis or melena. Ruptured cystic artery pseudoaneurysm is a rare cause of hemobilia, with 2 cases reported in Korea. We present this unusual condition in a 65-year-old man whose chief complaint was abdominal pain. His final diagnosis was ruptured cystic artery pseudoaneurysm, and he was successfully treated by transcatheter arterial embolization and laparoscopic cholecystectomy.
Abdominal Pain ; Aged ; Aneurysm, False* ; Arteries* ; Biliary Tract ; Cholecystectomy, Laparoscopic ; Diagnosis ; Hematemesis ; Hemobilia* ; Hemorrhage ; Humans ; Korea ; Melena

No abstract available.
Aged, 80 and over ; Cholecystitis/*complications/diagnosis ; Hemobilia/diagnosis/*etiology ; Humans ; Jaundice, Obstructive/etiology ; Male

Massive bleeding hemobilia occurs rarely in patients with hepatocellular carcinoma (HCC) without any invasive procedure. Upper gastrointestinal bleeding in patient with cirrhosis and abdominal pain with progressive jaundice in patient with HCC were usually thought as variceal bleeding and HCC progression respectively. We experienced recently massive bleeding hemobilia in patient with HCC who was a 73-year old man and showed sudden abdominal pain, jaundice and hematochezia. He had alcoholic cirrhosis and history of variceal bleeding. One year ago, he was diagnosed as HCC and treated with transarterial chemoembolization periodically. Sudden right upper abdominal pain occurred then subsided with onset of hemotochezia. Computed tomography showed bile duct thrombosis spreading in the intrahepatic and extrahepatic ducts, while an ampulla of vater bleeding was observed during duodenoscopy. Hemobilia could be one of the causes of massive bleeding in patients with cirrhosis and HCC especially when they had sudden abdominal pain and abrupt elevation of bilirubin.
Aged ; Bile Ducts, Extrahepatic ; Bile Ducts, Intrahepatic ; Bilirubin/analysis ; Carcinoma, Hepatocellular/complications/*diagnosis/therapy ; Duodenoscopy ; Embolization, Therapeutic ; Hemobilia/*etiology ; Humans ; Jaundice/etiology ; Liver Cirrhosis/complications ; Liver Neoplasms/complications/*diagnosis/therapy ; Male ; Severity of Illness Index ; Thrombosis/diagnosis ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Hemobilia is a rare cause of upper gastrointestinal bleeding. Endoscopic retrograde cholangiopancreaticography (ERCP) is considered to be an excellent diagnostic and treatment modality. Thirty-seven cases of hemobilia with different underlying pathologies were analyzed to illustrate clinical features and to evaluate the role of endoscopic management. METHODS: A total of 37 patients (26 men and 11 women; mean age, 66.2+/-15.3 years) who were confirmed to have hemobilia by ERCP in a single center from 2000 to 2010 were reviewed retrospectively. Patients with iatrogenic causes of hemobilia were excluded in this study. RESULTS: The causes of hemobilia were hepatocellular carcinoma in 14, bile duct and gallbladder malignancies in 12, common bile duct stones with cholangitis in 4, acute cholecystitis in 4, and pancreatic cancer in 2 patients. The clinical features of hemobilia were jaundice (89.2%), abdominal pain (78.4%), and melena (13.5%). The cholangiographic findings of hemobilia were amorphous filling defects in 15, tubular filling defects in 6, and cast-like filling defects in 6 patients. Endoscopic management included endoscopic nasobiliary drainage in 26 patients and endoscopic retrograde biliary drainage in 7 patients. Biliary obstruction caused by hemobilia was successfully treated with endoscopic biliary drainages in most cases. CONCLUSIONS: The most common non-iatrogenic causes of hemobilia were hepatobiliary malignancies, and the majority of patients presented with jaundice and abdominal pain. Endoscopic biliary drainage is recommended as the initial management to control biliary obstruction.
Abdominal Pain/etiology ; Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms/complications ; Carcinoma, Hepatocellular/complications ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystitis/complications ; Drainage ; Female ; Gallstones/complications ; Hemobilia/*diagnosis/etiology/therapy ; Humans ; Jaundice/etiology ; Liver Neoplasms/complications ; Male ; Middle Aged ; Pancreatic Neoplasms/complications ; Retrospective Studies

Hemorrhage in the gallbladder (GB) is usually associated with cholecystitis, GB neoplasm, trauma, hemobilia, and cystic artery aneurysm. Our patient had not experienced any previous abdominal trauma, and GB hemorrhage was unlikely to result from cholecystitis or bleeding diathesis. A 55-year-old male was admitted because of right upper quadrant pain. Both prothrombin time and partial thromboplastin time were normal. Abdominal computed tomography, endoscopic ultrasound and magnetic resonance cholangiopancreatography were performed. Image studies revealed GB wall thickening and an intraluminal mass. Laparoscopic cholecystectomy was performed. Upon opening the GB postoperatively, a large amount of fresh blood and old blood clot was noted. The incidence of GB hematoma is very rare. GB hematoma should always be considered in the differential diagnosis of GB tumor. In such a situation, surgical intervention is needed for further patient evaluation and management. We present a rare case of intramural GB hematoma, of which we were unable to make a definitive diagnosis preoperatively.
Aneurysm ; Arteries ; Cholangiopancreatography, Magnetic Resonance ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Diagnosis, Differential ; Disease Susceptibility ; Gallbladder ; Gallbladder Neoplasms ; Hematoma ; Hemobilia ; Hemorrhage ; Humans ; Incidence ; Male ; Middle Aged ; Partial Thromboplastin Time ; Prothrombin Time

Radiofrequency ablation (RFA) is performed as an alternative to surgical resection for primary or secondary liver malignancies. Although RFA can be performed safely in most patients, early and late complications related to mechanical or thermal damage occur in 8-9.5% cases. Hemocholecyst, which refers to hemorrhage of the gallbladder, has been reported with primary gallbladder disease or as a secondary event associated with hemobilia. Hemobilia, defined as hemorrhage in the biliary tract and most commonly associated with accidental or iatrogenic trauma, is a rare complication of RFA. Here we report a case of hemocholecyst associated with hemobilia after RFA for hepatocellular carcinoma that was successfully managed by laparoscopic cholecystectomy.
Aged ; Carcinoma, Hepatocellular/*surgery ; Catheter Ablation/*adverse effects ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Gallbladder Diseases/*etiology/surgery/ultrasonography ; Hemobilia/diagnosis/*etiology/surgery ; Hemorrhage/*etiology ; Humans ; Liver Neoplasms/*surgery ; Male ; Tomography, X-Ray Computed