Coils migrate into the biliary-jejunum anastomosis

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.

Intrabiliär migrierte Coils als Ursache für Choledocholithiasis bei Megacholedochus. Eine seltene Komplikation nach Coil-Embolisation eines Pseudoaneurysmas einer Leberarterie

“…Der Mechanismus, durch den Coils in den extravaskulären Organen migrieren, ist noch nicht ausreichend erforscht. Zwei potenzielle Ursachen könnte man im Betracht ziehen 4 :…”