Clinical Journal of Gastroenterology

, Volume 12, Issue 1, pp 46–51 | Cite as

Massive hemobilia following plastic stent removal in common bile duct cancer associated with primary sclerosing cholangitis (with video)

  • Hiroshi MiyamotoEmail author
  • Kumiko Tanaka
  • Fumika Nakamura
  • Takahiro Ikeda
  • Shinji Kitamura
  • Tetsuo Kimura
  • Koichi Okamoto
  • Masahiro Sogabe
  • Naoki Muguruma
  • Yoshimi Bando
  • Tetsuji TakayamaEmail author
Case Report


Hemobilia is defined as bleeding into the biliary tract. Herein, we report a very rare case of massive hemobilia following plastic stent (PS) removal in common bile duct (CBD) cancer. A 72-year-old man with primary sclerosing cholangitis had undergone repeated insertion of a PS into the CBD. Biliary tract biopsy was performed based on suspicion of combined CBD cancer. Biopsy revealed poorly differentiated adenocarcinoma of the CBD. One month after the biliary tract biopsy, he was admitted for acute cholangitis, and endoscopic retrograde cholangiography was performed for the exchange of the PS. When one of the two biliary PSs was removed, spurting bleeding from the major papilla began abruptly. The massive bleeding caused the patient to be in a pre-shock state. A retrieval balloon catheter was compressed against the papilla for hemostasis. Although he was treated conservatively, the patient developed a bloody discharge. Upper gastrointestinal endoscopy revealed that the pulsatile bleeding beside the PSs started immediately after the removal of the coagula. Emergent contrast-enhanced computed tomography showed right hepatic artery aneurysm across the CBD. Therefore, transarterial embolization was performed. The patient’s post-therapeutic course was uneventful. He received chemotherapy, but died about a half year after hemobilia occurred.


Hemobilia Plastic stent Biliary tract biopsy Primary sclerosing cholangitis Common bile duct cancer 


Compliance with ethical standards

Conflict of interest

Hiroshi Miyamoto, Kumiko Tanaka, Fumika Nakamura, Takahiro Ikeda, Shinji Kitamura, Tetsuo Kimura, Koichi Okamoto, Masahiro Sogabe, Naoki Muguruma, Yoshimi Bando, and Tetsuji Takayama declare that they have no conflict of interest.

Human rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments

Informed consent

Informed consent was obtained from all patients for being included in the study.

Supplementary material

Video 1 When one of the two biliary plastic stents (PS) was removed using a snare, pulsatile bleeding from the major papilla began abruptly. During the bleeding, cannulation of the major papilla was performed and a guidewire was inserted into the biliary tract. A retrieval balloon catheter (B-V232P-B, Olympus Medical Systems, Tokyo, Japan) was compressed against the major papilla for hemostasis. After cessation of the bleeding from the major papilla, one PS (Flexima Biliary Stent with Delivery System, 7FrX7cm, BOSTON SCIENTIFIC CORP., Marlborough, MA, USA) was reinserted into the biliary tract (MPG 7972 KB)


  1. 1.
    Sandblom P. Hemorrhage into the biliary tract following trauma; traumatic hemobilia. Surgery. 1948;24:571–86.Google Scholar
  2. 2.
    Yamauchi K, Uchida D, Kato H, et al. Recurrent bleeding from a hepatic artery pseudoaneurysm after biliary stent placement. Intern Med. 2018;57:49–52.CrossRefGoogle Scholar
  3. 3.
    Yasuda M, Sato H, Koyama Y, et al. Late-onset severe biliary bleeding after endoscopic pigtail plastic stent insertion. World J Gastroenterol. 2017;23:735–9.CrossRefGoogle Scholar
  4. 4.
    Chun JM, Ha HT, Choi YY, et al. Intrahepatic artery pseudoaneurysm-induced hemobilia caused by a plastic biliary stent after ABO-incompatible living-donor liver transplantation: a case report. Transpl Proc. 2016;48:3178–80.CrossRefGoogle Scholar
  5. 5.
    Tonozuka R, Itoi T, Sofuni A, et al. Hemostasis using a fully covered self-expandable metal stent for marked bleeding from the bile duct following stent removal (with videos). J Hepatobiliary Pancreat Sci. 2013;20:254–6.CrossRefGoogle Scholar
  6. 6.
    Inoue H, Tano S, Takayama R, et al. Right hepatic artery pseudoaneurysm: rare complication of plastic biliary stent insertion. Endoscopy. 2011;43(Suppl 2 UCTN):E396.CrossRefGoogle Scholar
  7. 7.
    Tsuji S, Itoi T, Sofuni A, et al. Life-threatening hemorrhage from the papilla following stent removal (with video). J Hepatobiliary Pancreat Sci. 2011;18:751–3.CrossRefGoogle Scholar
  8. 8.
    Frost A, Taylor MA, Parks RW. An unusual cause of haemobilia—beware the forgotten stent! Int J Clin Pract. 2007;61:877–8.CrossRefGoogle Scholar
  9. 9.
    Park JY, Ryu H, Bang S, et al. Hepatic artery pseudoaneurysm associated with plastic biliary stent. Yonsei Med J. 2007;48:546–8.CrossRefGoogle Scholar
  10. 10.
    Wolters F, Ryan B, Beets-Tan R, et al. Delayed massive hemobilia after biliary stenting. Endoscopy. 2003;35:976–7.CrossRefGoogle Scholar
  11. 11.
    Mutignani M, Shah SK, Bruni A, et al. Endoscopic treatment of extrahepatic bile duct strictures in patients with portal biliopathy carries a high risk of haemobilia: report of 3 cases. Dig Liver Dis. 2002;34:587–91.CrossRefGoogle Scholar
  12. 12.
    Conio M, Caroli-Bosc FX, Buckley M, et al. Massive hematobilia after extraction of plastic biliary endoprosthesis. J Clin Gastroenterol. 1997;25:706.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  1. 1.Department of Gastroenterology and OncologyTokushima University Graduate School of Biomedical SciencesTokushimaJapan
  2. 2.Department of PathologyTokushima University HospitalTokushimaJapan

Personalised recommendations