title: Potentially fatal haemobilia due to inappropriate use of an expanding biliary stent.
abstract: OBJECTIVE
  To highlight the fatal complication caused by expanding biliary stents and the importance of avoiding use of expanding stent in potentially curable diseases.
  
  
  METHODS
  Arteriobiliary fistula is an uncommon cause of haemobilia. We describe a case of right hepatic artery pseudoaneurysm causing arteriobiliary fistula and presenting as severe malena and cholangitis, in a patient with a mesh metal biliary stent. The patient had lymphoma causing bile duct obstruction.
  
  
  RESULTS
  Gastroduodenoscopy failed to establish the exact source of bleeding and hepatic artery angiography and selective embolisation of the pseudo aneurysm successfully controlled the bleeding.
  
  
  CONCLUSIONS
  Bleeding from the pseudo aneurysm of the hepatic artery can be fatal. Mesh metal stents in biliary tree can cause this complication as demonstrated in this case. So mesh metal stent insertion should be avoided in potentially benign or in curable conditions. Difficulty in diagnosis and management is discussed along with the review of the literature.
authors.affiliation: Hepatobiliary Surgery and Liver Transplant Unit, Freeman Hospital, Newcastle, UK. rai2000@hotmail.com
authors.forename: Rakesh
authors.initials: R
authors.lastname: Rai
authors.forename: John
authors.initials: J
authors.lastname: Rose
authors.forename: Derek
authors.initials: D
authors.lastname: Manas
mesh_terms: D017541:Aneurysm, False / Q000209:etiology; D001658:Biliary Fistula / Q000209:etiology*; D005260:Female; D006431:Hemobilia / Q000209:etiology*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*