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Oxf Med Case Reports. 2020 Feb 28;2020(2):omaa010. doi: 10.1093/omcr/omaa010. eCollection 2020 Feb.

Haemobilia in a previously stented hilar cholangiocarcinoma: successful haemostasis after the insertion of fcSEMS.

Author information

1
Department of Gastroenterology, Whipps Cross Hospital, Barts Health NHS Trust, London, UK.
2
General Practice, NHS Waltham Forest Clinical Commissioning Group, London, UK.

Abstract

Haemobilia describes blood loss from the biliary tract and classically presents as Quincke's triad: upper gastrointestinal bleeding (UGIB), jaundice and right upper quadrant abdominal pain. We discuss the case of a 70-year-old male with a previously stented Bismuth 1 hilar cholangiocarcinoma who presented with haematemesis. He had a similar presentation a month ago where a forward viewing gastroscope identified fresh and altered blood in the distal stomach but no clear source of bleeding. During this admission, a side-viewing duodenoscope identified bleeding from the periampullary region, which was managed by inserting a fully covered self-expanding metal stent (fcSEMS) within his pre-existing uncovered SEMS to tamponade the haemorrhage. This case highlights the importance of using a side-viewing duodenoscope for patients with UGIB on a background of a stented cholangiocarcinoma and inserting a fcSEMS within an uncovered SEMS is feasible and effective in managing these patients.

KEYWORDS:

SEMS; cholangiocarcinoma; haemobilia

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