Wake Forest Baptist Health Winston-Salem, NC, United States
Ted Xiao, MD1, Sharlene Dong, MD, MS2, Rishi Pawa, MD3, Swati Pawa, MD3 1Wake Forest Baptist Health, Winston-Salem, NC; 2University of Texas Southwestern Medical Center, Dallas, TX; 3Wake Forest University School of Medicine, Winston-Salem, NC
Introduction: Hepatic artery pseudoaneurysm is a rare cause of biliary tract complications. When suspected, CT imaging or angiography should be performed to help make a diagnosis. Embolization of the hepatic artery pseudoaneurysm can avoid serious complications or fatality. We present a case of migration of coils after endovascular intervention of the hepatic artery pseudoaneurysm resulting in acute cholangitis.
Case Description/Methods: An 87-year-old male was admitted with a two-day history of progressive abdominal pain, jaundice, and dark urine. His history was significant for a laparoscopic converted to open cholecystectomy 19 years ago, which was complicated by a cholecysto-gastric fistula and bleeding from the hepatic artery requiring coiling. The patient was doing well until recently when he presented with hypotension (92/45), obstructive jaundice (total bilirubin 3.8 mg/dL, Alkaline phosphatase: 274), and Klebsiella bacteremia. MRI showed coils within the atrophied right lobe of the liver along with the migration of coils into the intrahepatic ducts and a linear hyperdense material in the common bile duct (CBD). An ERCP showed a 1.5-cm bilirubinate stone in the CBD that was successfully removed post sphincterotomy and balloon sweeps. Cholangioascopy showed migrated coils in the right intrahepatic ductal system. Patient continued the appropriate antibiotic course and was discharged in stable condition.
Discussion: Hepatic artery pseudoaneurysm is an increasingly recognized complication of biliary surgery. Coil embolization has been the common practice in managing a saccular visceral pseudoaneurysm. We describe a rare case of migration of coil from a hepatic artery pseudoaneurysm via an arterial biliary fistula into the right hepatic duct. The migrated coil then went on to serve as a served as a nidus for stone formation, leading to choledocholithiasis and ascending cholangitis. Our case demonstrates that erosion and migration of the coil can lead to potentially life-threatening complications and must be taken into consideration in the decision-making process regarding coil embolization.
Figure: Radiographic and endoscopic imaging show coil remnants within the bilirubinate stone
Disclosures: Ted Xiao indicated no relevant financial relationships. Sharlene Dong indicated no relevant financial relationships. Rishi Pawa indicated no relevant financial relationships. Swati Pawa indicated no relevant financial relationships.
Ted Xiao, MD1, Sharlene Dong, MD, MS2, Rishi Pawa, MD3, Swati Pawa, MD3. P0098 - Cholangitis Due to Coil Migration After Embolization of a Hepatic Artery Pseudoaneurysm, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.