胆道ステント交換時に右肝動脈破綻による胆道出血を来した肝門部胆管癌の1例

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  • Massive bleeding due to rupture of a right hepatic artery pseudoaneurysm which developed after biliary EMS placement

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An 84-year-old man with hilar cholangiocarcinoma received endoscopic biliary drainage with an expandable metallic stent (EMS) and subsequent radiotherapy. Six months later, he presented with hematemesis. Immediate esophagogastroduodenoscopy and capsule endoscopy failed to reveal the bleeding source. Two weeks later, he presented with obstructive jaundice due to clogging of the EMS. Endoscopic removal of the clogged stents caused massive bleeding from the bile duct. Emergent angiography revealed a pseudoaneurysm of the right hepatic artery and leaking blood. Hemostasis was achieved by a transcatheter coil embolization. After that, no bleeding occured until he died 5 months later due to cancer progression. The pseudoaneurysm may have been caused by mechanical compression of the EMS on the adjacent tissue, and radiotherapy might have enhanced the development of the aneurysm.

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