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Elsayed M, Nezami N, Kokabi N, Scriver GM, Behairy MM, Majdalany BS. Percutaneous transhepatic cholangioscopy-guided lithotripsy and retrieval of vascular coils eroded into the biliary tree. Radiol Case Rep 2022; 18:444-448. [PMID: 36439934 PMCID: PMC9691415 DOI: 10.1016/j.radcr.2022.10.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/30/2022] [Indexed: 11/25/2022] Open
Abstract
Endovascular coil erosion into the biliary system after hepatic artery embolization is a rare complication which may result in inflammation, strictures, choledocholithiasis, biliary colic, and cholangitis. Removal of coils may result in cessation of these symptoms, but is challenging in patients who cannot undergo removal via standard endoscopic approaches. This case report describes the retrieval of coils placed across a hepatic artery pseudoaneurysm, which over several years eroded into the biliary tree, resulting in calculi formation and post-prandial pain. Using combined fluoroscopy and cholangioscopy via percutaneous transhepatic accesses, the calculi were fragmented and the coils were retrieved, resulting in cessation of symptoms.
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Affiliation(s)
- Mohammad Elsayed
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Geoffrey M. Scriver
- Division of Interventional Radiology, Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Patrick 124, Burlington, VT, 05401, USA
| | - Moataz M. Behairy
- Division of Interventional Radiology, Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Patrick 124, Burlington, VT, 05401, USA
| | - Bill S. Majdalany
- Division of Interventional Radiology, Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Patrick 124, Burlington, VT, 05401, USA,Corresponding author.
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Rivory J, Menassel B, Lambin T, Rostain F, Milot L, Ponchon T, Pioche M. Percutaneous cholangioscopy to remove endovascular coils that had migrated into the bile duct after right hepatic artery pseudoaneurysm embolization. Endoscopy 2021; 53:E448-E449. [PMID: 33540444 DOI: 10.1055/a-1322-1942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Jérôme Rivory
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Badis Menassel
- Department of Radiology, Pavillon B, Edouard Herriot Hospital, Lyon, France
| | - Thomas Lambin
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Florian Rostain
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Laurent Milot
- Department of Radiology, Pavillon B, Edouard Herriot Hospital, Lyon, France
| | - Thierry Ponchon
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Mathieu Pioche
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France.,Inserm U1032 LabTau, Lyon, France
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Lampropoulos C, Markopoulos G, Tsochatzis S, Bellou A, Amanatidis T, Kehagias D, Papadopoulos G, Kehagias I. Symptomatic pseudoaneurysms following laparoscopic cholecystectomy: Focus on an unusual and dangerous complication. J Minim Access Surg 2021; 17:450-457. [PMID: 34558424 PMCID: PMC8486062 DOI: 10.4103/jmas.jmas_164_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/03/2020] [Accepted: 09/20/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) has been associated with an increase in the incidence of biliary and vascular injuries. Pseudoaneurysms (PAs) following LC are rare life-threatening events with limited available experience regarding diagnosis and treatment. MATERIALS AND METHODS An extensive review of literature during a 26-year period (1994-2020) using MEDLINE® database and Google Scholar® academic search engine revealed 134 patients with at least one symptomatic PA following LC. RESULTS Nearly. 81% of patients with PAs become symptomatic during the first 8 weeks following LC. The most common symptoms were gastrointestinal bleeding (74%) and abdominal pain (61%). In 28% of cases, there was a concomitant bile duct injury or leak from the cystic duct stump, whereas in about one-third of cases, PAs presented following an uneventful LC. The most common involved arteries were the right hepatic artery (70%), the cystic artery (19%) or both of them (3%). Trans-arterial embolisation was the favoured first-line treatment with a success rate of 83%. During a median follow-up of 9 months, the mortality rate was 7%. CONCLUSION Clinicians should be aware of the PA occurrence following LC. Prompt diagnosis and treatment are essential.
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Affiliation(s)
| | | | | | - Aggeliki Bellou
- Department of Pulmonary Medicine, General University Hospital of Patras, Patras, Greece
| | | | - Dimitrios Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | | | - Ioannis Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
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Frandah WM, Fiore N, Sherif M, Emhmed Ali S, Sherif AM. Endoscopic diagnosis and management of chronic relapsing pancreatitis due to eroded embolization coils. Endoscopy 2020; 52:E448-E449. [PMID: 32396952 DOI: 10.1055/a-1163-7195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Wesam M Frandah
- Department of Gastroenterology and Therapeutic endoscopy, Banner health, Greeley, Colorado, United States
| | - Nicolas Fiore
- College of Osteopathic Medicine, Rocky Vista University, Parker, Colorado, United States
| | - Merall Sherif
- Division of Neuroscience, Colorado State University, Fort Collins, Colorado, United States
| | - Saad Emhmed Ali
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, United States
| | - Ahmed M Sherif
- Department of Gastroenterology and Therapeutic endoscopy, Banner health, Greeley, Colorado, United States
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A Curious Case of Coil-Angitis. ACG Case Rep J 2019; 6:e00078. [PMID: 31616751 PMCID: PMC6658066 DOI: 10.14309/crj.0000000000000078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/28/2019] [Indexed: 11/20/2022] Open
Abstract
A 43-year-old man with a history of pedestrian-truck collision 18 months prior presented with right-sided abdominal pain and chills. His trauma consisted of orthopedic injuries and a grade 4 liver laceration. Surgical liver repair was complicated by a biloma requiring common bile duct stenting. Postendoscopy hemobilia led to extensive coiling of a hepatic artery pseudoaneurysm. Remaining hospitalization was relatively uneventful, and he was lost to follow-up. Repeat presentation was marked by leukocytosis and obstructive transaminitis. Computed tomography raised concern for a dilated 14-mm common bile duct with migrated coil mass near the pancreatic head. The patient underwent urgent endoscopic retrograde cholangiopancreatography with cholangioscopy and successful removal of a coil mass measuring approximately 4 × 3 cm without injury to the common bile duct or vascular structures. His pain was relieved, and he was discharged with a common bile duct stent and outpatient follow-up.
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Xu J, Zhan H, Li F, Hu S, Wang L. Coils migrate into the biliary-jejunum anastomosis: A case report. Medicine (Baltimore) 2019; 98:e13640. [PMID: 30732121 PMCID: PMC6380664 DOI: 10.1097/md.0000000000013640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Coils migration following endovascular treatment of arterial bleeding is rare. There was no clear route to deal with this complication. PATIENT CONCERNS A 55-year-old woman underwent choledochal cyst excision with hepaticojejunostomy. At the 18th day after operation, intra-abdominal hemorrhage occurred. Angiography showed active bleeding of 1 branch of the right hepatic artery and the gastroduodenal artery. That was treated by micro-coils embolization. 122 days after embolization, the patient was readmitted for chills, fever with temperature of 40°C, and jaundice. DIAGNOSIS Obstructive cholangitis. INTERVENTIONS Endoscopy was performed, which showed the micro-coils were embedded in biliary-jejunum anastomosis. Biliary sludges were adherent around micro-coils that were considered the cause of obstructive jaundice, which were washed by endoscopy. OUTCOMES Two days later endoscopy therapy, the total bilirubin (TBIL) was decreased to 58.7 μmol/L, and the patient was discharged. After 2 months of follow-up, the level of TBIL was in normal range. LESSONS Coils migration following endovascular treatment of arterial bleeding is rare. For cases with coils migrated into the biliary tract, further treatment is often needed because of the secondary cholangitis or stones. Endoscopy might be useful to deal with this intractable problem.
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Zuberi OS, Dinglasan LAV. Biliary obstruction necessitating choledochojejunostomy as a complication of endovascular coil erosion. Radiol Case Rep 2018; 13:167-170. [PMID: 29552256 PMCID: PMC5851436 DOI: 10.1016/j.radcr.2017.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/09/2017] [Accepted: 10/09/2017] [Indexed: 11/19/2022] Open
Abstract
We report the case of a 55-year-old patient presenting with biliary obstruction caused by coil migration from a recently performed embolization of a post-traumatic gastroduodenal artery pseudoaneurysm. Based on imaging findings, biliary drain placement was initially performed and the subsequent endoscopy demonstrated coil erosion into the common bile duct and duodenum, resulting in choledochoduodenal fistula. Choledochojejunostomy was thereafter performed to bypass the area of injury.
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Corral JE, Woodward TA, Lukens FJ. All Wired Up: Migration of Endovascular Coils to the Common Bile Duct. Clin Gastroenterol Hepatol 2018; 16:A23-A24. [PMID: 28428101 DOI: 10.1016/j.cgh.2017.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/05/2017] [Accepted: 04/07/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Juan E Corral
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Timothy A Woodward
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Frank J Lukens
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
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Zaafouri H, Hasnaoui A, Essghaeir S, Haddad D, Sabbah M, Bouhafa A, Kharrat J, Ben Maamer A. Ascending Cholangitis secondary to migrated embolization coil of gastroduodenal artery pseudo-aneurysm a case report. BMC Surg 2017; 17:30. [PMID: 28330448 PMCID: PMC5363039 DOI: 10.1186/s12893-017-0227-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/16/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Gastroduodenalartery (GDA) pseudo-aneurysms are very rare. Their clinical importance lies in the eventuality of rupture, causing bleeding and ultimately exsanguination. CASE PRESENTATION We report the case of a man, with prior history of biliary surgery, presenting with haemobilia secondary to a rupture of GDA pseudo-aneurysm eroding the main bile duct. The patient was treated with coil embolization. This technique is considered to be safe. However, on the long term, some complications may occur. In our case, the patient presented with cholangitis subsequent to coil migration in the lower bile duct. This situation was managed using endoscopic retrograde cholangiopancreatography (ERCP) allowing coil extraction with favorable evolution. CONCLUSIONS GDA pseudo-aneurysms are very rare. Bleeding, secondary to the rupture of these lesions, is a serious complication that could lead to death. Diagnosis and treatment of ruptured GDA pseudo-aneurysms rely on angiography. This method is considered to be safe. Cholangitis secondary to coil migration in the main bile duct is exceedingly rare,but remains an eventuality that physicians should be cognizant of.
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Affiliation(s)
- Haithem Zaafouri
- Department of General Surgery Habib Thameur Hospital, Ali Ben Ayed Street's 2037 Montfleury, Tunis, Tunisia.
| | - Anis Hasnaoui
- Department of General Surgery Habib Thameur Hospital, Ali Ben Ayed Street's 2037 Montfleury, Tunis, Tunisia
| | - Sonia Essghaeir
- Department of Radiology Habib Thameur Hospital, Tunis, Tunisia
| | - Dhafer Haddad
- Department of General Surgery Habib Thameur Hospital, Ali Ben Ayed Street's 2037 Montfleury, Tunis, Tunisia
| | - Meriam Sabbah
- Department of Gastroenterology Habib Thameur Hospital, Tunis, Tunisia
| | - Ahmed Bouhafa
- Department of General Surgery Habib Thameur Hospital, Ali Ben Ayed Street's 2037 Montfleury, Tunis, Tunisia
| | - Jamel Kharrat
- Department of Gastroenterology Habib Thameur Hospital, Tunis, Tunisia
| | - Anis Ben Maamer
- Department of General Surgery Habib Thameur Hospital, Ali Ben Ayed Street's 2037 Montfleury, Tunis, Tunisia
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