Jui-Sheng Hunga, Andy Shau-Bin Choub, Chien-Lin Chena
a Department of Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
b Department of Radiology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
Abstract
We report a 64-year-old man who presented with upper gastrointestinal bleeding that was complicated by shock secondary to hemobilia. He had passed tarry stools for two days. In the previous month, the patient had undergone surgery for biliary lithiasis with acute cholangitis. Despite two consecutive upper endoscopies on two successive days, the patient remained hemodynamically unstable. Computed tomography and angiography subsequently revealed an outpouching lesion as a pseudoaneurysm from the orifice of the middle hepatic artery. Hemostasis was achieved by angioembolization of the middle hepatic pseudoaneurysm. The patient had a stable level of hemoglobin by discharge. Hemorrhagic shock resulting from hepatic pseudoaneurysm is difficult to diagnose and has a high mortality rate. We were able to make the diagnosis quickly and treat him successfully with percutaneous embolization.
Keywords
Hemobilia; Hepatic artery aneurysm; Pseudoaneurysm
