Life-threatening hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy: report of a case.
BACKGROUND
Hemobilia is a rare but lethal biliary tract complication. There are several causes of hemobilia which might be classified as traumatic or nontraumatic. Hemobilia caused by pseudoaneurysm might result from hepatobiliary surgery or percutaneous interventional hepatobiliary procedures. However, to our knowledge, there are no previous reports pertaining to hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy.


METHODS
A 65-year-old male was admitted to our hospital because of acute calculous cholecystitis and cholangitis. He underwent cholecystectomy, choledocholithotomy via a right upper quadrant laparotomy and a temporary T-tube choledochostomy was created. However, on the 19th day after operation, he suffered from sudden onset of hematemesis and massive fresh blood drainage from the T-tube choledochostomy. Imaging studies confirmed the diagnosis of pseudoaneurysm associated hemobilia. The probable association of T-tube choledochostomy with pseudoaneurysm and hemobilia is also demonstrated. He underwent emergent selective microcoils emobolization to occlude the feeding artery of the pseudoaneurysm.


CONCLUSIONS
Pseudoaneurysm associated hemobilia may occur after T-tube choledochostomy. This case also highlights the importance that hemobilia should be highly suspected in a patient presenting with jaundice, right upper quadrant abdominal pain and upper gastrointestinal bleeding after liver or biliary surgery.
Lee
Yueh-Tsung
YT
Department of Surgery, Chang-Bing Show Chwan Memorial Hospital, Changhua County, Taiwan, ROC.
Lin
Ho
H
Chen
Kuan-Yung
KY
Wu
Hurng-Sheng
HS
Hwang
Min-Ho
MH
Yan
Sheng-Lei
SL
D000368:Aged; D017541:Aneurysm, False / Q000150:complications* / Q000209:etiology*; D002761:Cholangitis / Q000601:surgery; D002763:Cholecystectomy; D041881:Cholecystitis, Acute / Q000601:surgery; D002768:Choledochostomy / Q000009:adverse effects* / Q000379:methods; D006431:Hemobilia / Q000175:diagnosis / Q000209:etiology*; D006499:Hepatic Artery; D006801:Humans; D008297:Male