Common bile duct blood clot: an unusual cause of ductal filling defects for calculi

Abstract

We report a case of obstructive jaundice caused by a blood clot in the common bile duct in a 75-year-old man with cirrhosis. Five years prior to his admission, he had undergone a left hepatectomy for hepatocellular carcinoma. At the present admission, he appeared icteric, and endoscopic retrograde cholangiography revealed filling defects in the common bile duct. Choledochotomy was therefore performed for possible common duct stones, and exploration of the duct showed blood clot casts filling the duct. The casts were easily removed, and the patient's postoperative course was uneventful. However, he developed ascites and jaundice 1 month later and died of liver failure approximately 3 months after undergoing the choledochotomy. Autopsy revealed hemorrhagic necrosis in the proximal intrahepatic duct of the posterior segment, which was considered to be the cause of the observed hemobilia, as well as the blood clot in the common bile duct at surgery. We report this rare case and discuss the cause of hemobilia.

Haemobilia

“…The morphology of these defects is variable. String-like defects may occur if the clots have formed a cast of the biliary tree 28 , or smaller spherical defects may be seen 118 (it is of particular importance to discriminate these from gallstones 89,138 ). Aneurysm or pseudoaneurysm of the hepatic artery may cause indentation of the bile duct, and biloma may be noted 179 .…”

Acute biliary obstruction due to a large intracholedochal hematoma after living-donor liver transplantation: Report of a case

“…13,14 There have been few reports on the development of a blood clot in the common bile duct after a hepatectomy. 15 However, hemobilia after LDLT, unlike that after a hepatectomy, is usually related to a percutaneous liver biopsy or percutaneous transhepatic cholangiography. 9,10 However, the current patient had not undergone either of these two procedures.…”