title: Three complications of Pair (puncture, aspiration, injection, reaspiration) in one case: Recurrent hemobilia, cyst infection and pneumonia.
abstract: BACKGROUND
  With the appropriate indications, puncture, aspiration, injection and reaspiration (PAIR) is the most effective minimal invasive method used in the treatment of hydatic cysts. Hemobilia is the hemorrhagia in bile ducts in consequence of any reason. In literature there is no case with hemobilia because of PAIR. This is the first case with recurrent hemobilia, infection in cyst cavity and pneumonia because of PAIR.
  
  
  METHODS
  A 66 years old female patient was admitted to hospital with complaints of abdominal pain, hematemesis and melaena. She gave the history of PAIR for two hydatic cysts. At physical examination, there were jaundice, tenderness at right subcostal area and melaena at rectal digital examination. Hemobilia was detected by abdominal ultrasonography and magnetic resonance cholangiopancreaticography (MRCP). An endoscopic retrograde cholangiopancreaticography (ERCP) and endoscopic sphincterotomy were performed. The patient was discharged after 6 days hospital stay. One day after the discharge the patient was admitted to hospital with the same complaints again. Performing ERCP and balloon extraction, the hematoma filling the common bile duct was removed. After the patient was hemodynamically stable for 3 days, she was discharged from the hospital. A week after that the patient was admitted to hospital with the clinical findings of infected hydatic cyst and pneumonia. The patient was treated medically with mechanical ventilation support for 8 days.
  
  
  CONCLUSIONS
  It should not be underestimated that, there can be serious complications of PAIR like hemobilia. Therefore, PAIR should be performed only in centers having appropriate medical and surgical facilities.
authors: Sarıkaya State Hospital, General Surgery Clinic, Turkey. Electronic address: drbarissevinc@gmail.com.
authors: B
authors: B
authors: Sevinç
authors: Konya University, Meram Medical Faculty, General Surgery Clinic, Turkey.
authors: Ö
authors: Ö
authors: Karahan
authors: Konya Education and Research Hospital, Radiology Department, Turkey.
authors: S
authors: S
authors: Bakdik
authors: Konya Education and Research Hospital, General Surgery Clinic, Turkey.
authors: N
authors: N
authors: Aksoy
authors: Konya Education and Research Hospital, General Surgery Clinic, Turkey.
authors: M A
authors: MA
authors: Eryilmaz
keywords: ERCP; Hemobilia; Hydatid Cyst; PAIR