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• W2914549627 abstract "Introduction: Hepatic artery pseudoaneurysm is a rare complication of abdominal trauma, abdominal surgery, and percutaneous biliary procedures that is associated with high mortality. Endovascular treatment such as coil embolization had been commonly used as it tends to have lower complication rate over surgical open repair. Here we present an uncommon complication of coil embolization where the coils have eroded into the gastrointestinal tract leading to bile stasis and stone formation with subsequent development of anastamotic stricture. Case Description: A 55 year old male who presented with fever, chills, vomiting and elevated liver function tests (LFTs). Nine months prior to presentation, patient underwent laparoscopic cholecystectomy converted to open cholecystectomy secondary to common bile duct transection with subsequent Roux-en-Y hepaticojejunostomy. Course was complicated by 2 episodes of right hepatic artery pseudoaneurysm bleeding treated with coil embolization. He was doing well for 6 months until he presented with the above symptoms. LFTs revealed alkaline phosphatase 881U/L, ALT 184U/L, AST 153U/L, total bilirubin 1.1mg/dL, direct bilirubin 0.4mg/dL. CT abdomen was unremarkable. Single balloon assisted ERCP revealed coils from pseudoaneurysm that had eroded into gastrointestinal tract at the hepaticojejunostomy anastomosis with stone material entangled in the coils (Figure 1). The coils and debris were removed with a combination of rat tooth forceps and endoscopic scissors, however, his symptoms and abnormal LFTs persisted. Repeat single balloon ERCP was attempted, but failed secondary to inability to cannulate the severe anastamotic stricture. He underwent percutaneous transhepatic cholangiography and internal/external biliary drainage, which provided resolution of symptoms and normalization of LFTs. Long term plan is to gradually upsize the drain followed by balloon dilatation of the stricture.Figure: ERCP showing coils with stone material.Discussion: Our patient developed a rare complication of coil embolization of hepatic artery pseudoaneurysm with a vague manifestation of fever, vomiting and biliary obstruction. He was eventually found to have coils eroding into the GI tract leading to bile stasis and stone formation which in combination with ischemia from pseudoaneurysm embolization, led to rapid formation of a severe anastamotic stricture." @default.
• W2914549627 created "2019-02-21" @default.
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• W2914549627 date "2017-10-01" @default.
• W2914549627 modified "2023-09-27" @default.
• W2914549627 title "Coils at the Hepaticojejunostomy" @default.
• W2914549627 doi "https://doi.org/10.14309/00000434-201710001-01388" @default.
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