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Purpose: To evaluate the effectiveness of interventional management for delayed and massive hemobilia secondary to arterial erosion self expandable metallic stent (SES) in with biliary duct malignancy. Materials and Methods: Over 8-year period, eight patients who suffered from delayed massive hemobilia after SES placement for malignant biliary obstruction as palliative procedure, were included. The mean period between SES placement and presence of massive gastrointestinal hemorrhage was 66.5 days (15-152 days), pancreatic cancer (n = 2), Klatskin tumor (n = 2), common bile duct cancer (n = 2), intrahepatic cholangiocarcinoma (n = 1), and gastric cancer with ductal invasion (n = 1). Angiographic findings were pseudoaneurysm (n = 6), contrast extravasation (n = 1) and arterial spasm at segment (n = 1). Six patients underwent embolization of injured vessels using microcoils and N-butyl cyanoacrylate. Two patients underwent stent graft placement at right hepatic artery to prevent ischemic hepatic damage because of the presence of portal vein occlusion. Results: Massive hemobilia was successfully controlled by the embolization of arteries (n = 6) and stent graft placement (n = 2) without related complications. Conclusion: The delayed massive hemobilia to arterial erosion metallic biliary stent is rare this complication be successfully treated by interventional management.

Interventional Management of Delayed and Massive Hemobilia due to Arterial Erosion by Metallic Biliary Stent