Ruptured left hepatic artery pseudoaneurysm caused by a half-pigtail type biliary stent: a case report with literature review.

A 74-year-old woman underwent endoscopic retrograde cholangiopancreatography because of obstructive jaundice, caused by pancreatic cancer. The patient received a plastic biliary stent (half-pigtail type) placement into the left hepatic bile duct for biliary drainage. After 28 days, the patient presented to our hospital with fever and jaundice. Emergent endoscopic retrograde cholangiopancreatography revealed bleeding from the papilla and blood clots filling the entire bile duct. To treat the hemobilia, endoscopic nasobiliary drainage was performed after placement of a self-expandable metallic stent in the common bile duct. Frequent irrigation of the bile duct failed to remove the clots. Although endoscopic retrograde cholangiopancreatography was repeated to remove the clots, fresh blood flowed from the bile duct. Enhanced computed tomography revealed a left hepatic artery pseudoaneurysm that had likely ruptured into the bile duct. Following successful transcatheter arterial embolization, there was no recurrent bleeding. Since the tip of the stent was located at the site of the pseudoaneurysm, it was suspected that stent insertion caused the complication. This report describes a rare case of hemobilia of a hepatic artery pseudoaneurysm caused by insertion of a half-pigtail type biliary stent into the left hepatic duct. The case was successfully treated with embolization.