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Medline ® Abstract for Reference 173

of 'Rare complications of endoscopic retrograde cholangiopancreatography (ERCP)'

Potentially fatal haemobilia due to inappropriate use of an expanding biliary stent.
Rai R, Rose J, Manas D
World J Gastroenterol. 2003;9(10):2377.
AIM: 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.
CONCLUSION: 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.
Hepatobiliary Surgery and Liver Transplant Unit, Freeman Hospital, Newcastle, UK. rai2000@hotmail.com