SHM Converge Scientific Abstract ePoster Gallery-Hepatic Artery Pseudoaneurysm Rupture: A Rare Etiology of Hemobilia

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This Mayo Clinic case report describes a rare and life-threatening cause of hemobilia: rupture of a hepatic artery pseudoaneurysm. Hemobilia is bleeding into the biliary tree caused by an abnormal connection between the biliary system and blood vessels, and it is an uncommon source of upper gastrointestinal bleeding. Most cases are related to procedures, trauma, or malignancy, making pseudoaneurysm rupture especially unusual.<br /><br />The patient was a 49-year-old man with cirrhosis and hepatocellular carcinoma due to alcohol use and alpha-1 antitrypsin deficiency, who had undergone liver transplantation one month earlier. His postoperative course had been complicated by a bile leak at the biliary anastomosis requiring stenting, and he was on immunosuppression. He initially presented with fever, chills, headache, nausea, right upper quadrant pain radiating to the back, and signs of cholestasis and anemia. CT imaging revealed a new common hepatic artery pseudoaneurysm without obvious active bleeding. He also had Streptococcus anginosus bacteremia.<br /><br />During hospitalization, he developed massive melena and hematemesis, followed by syncope and hemorrhagic shock. He required ICU care, intubation, and experienced multiple PEA arrests, receiving extensive blood transfusions. Endoscopy suggested bleeding from the duodenum with strong suspicion for hemobilia. Emergency celiac angiography confirmed rupture of the hepatic artery pseudoaneurysm with brisk bleeding into the bile duct and then the duodenum. The pseudoaneurysm was embolized successfully.<br /><br />After stabilization, the patient was extubated, remained hemodynamically stable, and ultimately underwent a second liver transplant. The authors emphasize that hemobilia should be considered in patients with upper GI bleeding, especially when accompanied by hyperbilirubinemia and a history of liver transplant or biliary instrumentation.

Asset Subtitle

Bibek Saha

Meta Tag

Author List Anjul Verma, Bibek Saha, Joelle N. Friesen, Victoria Kalinoski-DuBose, William Mundell

Category Clinical Vignettes

Concept Hemobilia

Concept Upper Gastrointestinal Bleeding

Concept Hepatic Artery Pseudoaneurysm

Concept Digital Subtraction Angiography

Concept Embolization

Distinguished Non-Finalist

Presenter Organization Mayo Clinic Rochester, MN

Presenting Author Bibek Saha

Track Adult

Keywords

hemobilia

hepatic artery pseudoaneurysm

liver transplantation

upper gastrointestinal bleeding

biliary tree bleeding

melena

hematemesis

embolization

biliary instrumentation

hepatocellular carcinoma

Hemobilia

Upper Gastrointestinal Bleeding

Hepatic Artery Pseudoaneurysm

Digital Subtraction Angiography

Embolization