Case Report The Korean Journal of Pancreas and Biliary Tract 2014;19(1):42-46 pissn eissn 개복담낭절제술후오랜기간후에발생한혈액담즙증 1 예 가톨릭대학교의과대학내과학

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1 Case Report The Korean Journal of Pancreas and Biliary Tract 2014;19(1):42-46 pissn eissn 개복담낭절제술후오랜기간후에발생한혈액담즙증 1 예 가톨릭대학교의과대학내과학교실 1, 청주성모병원내과 2, 영상의학과 3, 충북대학교의과대학내과학교실 4 정지선 1,2 ㆍ음영욱 2 ㆍ장지혜 1 ㆍ정은 1 ㆍ양현 1 ㆍ김현선 1 ㆍ배일헌 3 ㆍ박선미 4 A Case of Massive Hemobilia after a Long Period of Time Since Open Cholecystectomy Jee Sun Jeong 1,2, Young Ook Eum 2, Ji Hye Jang 1, Hyun Yang 1, Eun Chung 1, Hyun Seon Kim 1, Il Hun Bae 3, Seon Mee Park 4 1 Department of Internal Medicine, Catholic University College of Medicine, Seoul; 2 Department of Internal Medicine, Cheongju St. Mary Ospital, Cheongju; 3 Department of Radiology, Cheongju St. Mary Hospital, Cheongju; 4 Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea A 77-year-old woman was admitted with 5 days history of melena. She had an open cholecystectomy 30 years ago. Abdominal computed tomography and duodenoscopy revealed massive hemobilia. Angiography showed right hepatic arterial fistula to common bile duct near the surgical clip. Embolization was done successfully and the patient recovered. We experienced a case of a massive hemobilia which was occurred after a long period of time since open cholecystectomy without pseudoaneurysmal change of the right hepatic artery. And we suggest the direct vessel injury and fistula between the bile duct and a blood vessel as a possible cause of hemobilia in this case. Keywords: Hemobilia, Cholecystectomy, Bile duct injury Korean J Pancreatobiliary 2014;19(1):42-46 Received Revised Accepted Corresponding author : Young Ook Eum Department of Internal Medicine, Cheongju St. Mary Hospital, Juseong-ro, Sangdang-gu, Cheongju , Korea Tel Fax ; vesal@hanmail.net This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( creativecommons.org / licenses/by-nc/3.0/ ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright 2014 by The Korean Journal of Pancreas and Biliary Tract 서론 1948 Sandblom % 42, % 4. 1, The Korean Journal of Pancreas and Biliary Tract

JS Jeong, et al. Hemobilia after Cholecystectomy. 증례 77 5., 30. 170/100 mmhg, 110, 20, 38.

(Fig. 1A) (Fig. 1B). (endoscopic nasobiliary drainage).. 90 mmhg 8.6 g/ dl. (Fig. 2). (Fig. 3A) (Fig.

Active bleeding on duodenal second portion was noted and could not find ampulla of Vater.

2 JS Jeong, et al. Hemobilia after Cholecystectomy. 증례 77 5., /100 mmhg, 110, 20, 38.3 Murphy s sign. 9,810/uL, 10.8 g/dl, 109,000/uL 259 IU/L, 159 IU/L, 4.0mg/dL, 314 mg/dl. (Fig. 1A) (Fig. 1B). (endoscopic nasobiliary drainage).. 90 mmhg 8.6 g/ dl. (Fig. 2). (Fig. 3A) (Fig. 3B).. Fig. 2. Active bleeding on duodenal second portion was noted and could not find ampulla of Vater. A B Fig. 1. (A) Intrahepatic duct dilation with postcholecystectomy clip. (B) Hemorrhage from ampulla of Vater on duodenoscopic finding. 43

(B) After embolization, the arterogram shows coils obstructing right hepatic artery with complete

3 Volume_19 Number_1 January 2014 A Fig. 3. (A) Aarterobiliary fistula (arrow) was found on angiography at the moment of bleeding. (B) After embolization, the arterogram shows coils obstructing right hepatic artery with complete disappearance of hemobilia. B. 고찰 Sansonna % % %. 70%, 60%,, Quincke s triad 20-40%.,,, %,. 4-7,. 8,9.,, 44 The Korean Journal of Pancreas and Biliary Tract

4 JS Jeong, et al. Hemobilia after Cholecystectomy ,, 요약 국문색인 : 혈액담즙증, 담낭절제술, 담도손상 Conflicts of Interest The authors have no conflicts to disclose. REFERENCES 1. Joel JR, Gregory SB, Edward FXH, Kimberly SK, Michael JZ, Joe AC. Open cholecystectomy. A contemporary Analysis of 42,474 Patients. Annals of Surgery 1993;218: Sansonna F, Boati S, Sguinzi R, Migliorisi C, Pugliese F, Pugliese R. Severe hemobilia from hepatic artery pseudoaneurysm. Case Rep Gastrointest Med 2011; 2011: Athanasios Petrou, Nicholas Brennan, Zahir Soonawalla, Michael Anthony Silva. Hemobilia Due to Cystic Artery Stump Pseudoaneurysm Following Laparoscopic Cholecystectomy: Case Presentation and Literature Review. Int Surg 2012;97: Ribeiro A, Williams H, May G, Fulmer JT, Spivey JR. Hemobilia due to hepatic artery pseudoaneurysm thirteen months after laparoscopic cholecystectomy. J Clin Gastroenterol 1998;26: Lennard TW, Plusa SM, Forsythe JL, Richardson DL. Treatment of right hepatic artery injury by percutaneous embolisation. Lancet 1994; 344: Bulut T, Yamaner S, Bugra D, Akyuz A, Acarli K, Poyanli A. False aneurysm of the hepatic artery after laparoscopic cholecystectomy. Acta Chir Belg 2002;102: Heyn J, Sommerey S, Schmid R, Hallfeldt K, Schmidbauer S. Fistula between cystic artery pseudoaneurysm and cystic bile duct cause of acute anemia one year after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2006;16: Yao CA, Arnell TD. Hepatic artery pseudoaneurysm following laparoscopic cholecystectomy. Am J Surg 2010;199:e Madanur MA, Battula N, Sethi H, Deshpande R, Heaton N, Rela M. Pseudoaneurysm following laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int 2007;6: Genyk YS, Keller FS, Halpern NB. Hepatic artery pseudoaneurysm and hemobilia following laser laparoscopic cholecystectomy. A case report. Surg Endosc 1994;8: Bloch P, Modiano P, Foster D, Bouhot F, Gompel H. Recurrent hemobilia after laparoscopic cholecystectomy. Surg Laparosc Endosc 1994; 4: Porte RJ, Coerkamp EG, Koumans RK. False aneurysm of a hepatic artery branch and a recurrent subphrenic abscess: two unusual com- 45

5 Volume_19 Number_1 January 2014 plications after laparoscopic cholecystectomy. Surg Endosc 1996; 10: Siablis D, Tepetes K, Vasiou K, Karnabatidis D, Perifanos S, Tzorakoleftherakis E. Hepatic artery pseudoaneurysm following laparoscopic cholecystectomy: transcatheter intraarterial embolization. Hepatogastroenterology 1996;43: The Korean Journal of Pancreas and Biliary Tract

노영남

노영남 Purpose: Delayed massive hemorrhages from pseudoaneurysm rupture of the peripancreatic large arteries, after pancreaticoduodenectomy, are fatal. We reviewed the clinical course and outcome of bleeding