title: Hemorrhage from bile duct varices treated with fully covered expandable metallic stent placement in pancreatic carcinoma.
abstract: A 64-year-old woman with unresectable pancreatic body carcinoma was admitted with epigastralgia with a sudden onset 6 h earlier. She had received chemotherapy for her cancer for 2 months. Physical examination showed mild anemia. Contrast-enhanced computed tomography showed dilated vessels in the bile duct walls connecting with dilated and tortuous vessels around the extrahepatic bile duct and portal vein obstruction due to invasion by a pancreatic body tumor. Endoscopic examination showed transpapillary hemorrhage suggesting bile duct hemorrhage. On endoscopic retrograde cholangiopancreatography, the lower bile duct was filled with a mass and the middle bile duct had filling defects with compression of the wall. To stop the bleeding, we placed a fully covered expandable metallic stent (EMS) at the middle to lower portion of the bile duct, and the hemorrhage stopped. Bile duct hemorrhage is not a common disorder. This report shows bile duct hemorrhage from bile duct varices can occur in patients with pancreatic carcinoma with portal obstruction and that fully covered EMS placement can stop the hemorrhage.
authors.affiliation: Department of Gastroenterology, Shizuoka General Hospital, 4-27-1, Kita-ando, Aoiku, Shizuoka, Shizuoka, 420-8527, Japan.
authors.forename: Chisato
authors.initials: C
authors.lastname: Ueda
authors.affiliation: Department of Gastroenterology, Shizuoka General Hospital, 4-27-1, Kita-ando, Aoiku, Shizuoka, Shizuoka, 420-8527, Japan. kikuyama110@yahoo.co.jp.
authors.forename: Masataka
authors.initials: M
authors.lastname: Kikuyama
authors.affiliation: Department of Gastroenterology, Shizuoka General Hospital, 4-27-1, Kita-ando, Aoiku, Shizuoka, Shizuoka, 420-8527, Japan.
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Ueda
authors.affiliation: Department of Gastroenterology, Shizuoka General Hospital, 4-27-1, Kita-ando, Aoiku, Shizuoka, Shizuoka, 420-8527, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Kurokami
keywords: Bile duct hemorrhage; Expandable metallic stent; Pancreatic cancer