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Arterio-Biliary Fistula as a Rare Life-Threatening Complication of Transjugular Intrahepatic Portosystemic Shunt: A Case Report

경경정맥 간내 문맥 정맥 단락술 후 드물게 발생하는 동맥-담관루: 증례 보고

  • Ji Su Ko (Department of Radiology, Hallym University Kangnam Sacred Heart Hospital) ;
  • Lyo Min Kwon (Department of Radiology, Hallym University Sacred Heart Hospital) ;
  • Han Myun Kim (Department of Radiology, Hallym University Kangnam Sacred Heart Hospital) ;
  • Min-Jeong Kim (Department of Radiology, Hallym University Sacred Heart Hospital) ;
  • Hong Il Ha (Department of Radiology, Hallym University Sacred Heart Hospital) ;
  • Ji Won Park (Department of Internal Medicine, Hallym University Sacred Heart Hospital) ;
  • Ji Young Woo (Department of Radiology, Hallym University Kangnam Sacred Heart Hospital)
  • 고지수 (한림대학교 강남성심병원 영상의학과) ;
  • 권려민 (한림대학교 성심병원 영상의학과) ;
  • 김한면 (한림대학교 강남성심병원 영상의학과) ;
  • 김민정 (한림대학교 성심병원 영상의학과) ;
  • 하홍일 (한림대학교 성심병원 영상의학과) ;
  • 박지원 (한림대학교 성심병원 내과) ;
  • 우지영 (한림대학교 강남성심병원 영상의학과)
  • Received : 2021.05.08
  • Accepted : 2021.08.03
  • Published : 2022.05.01

Abstract

A 46-year-old male with alcoholic liver cirrhosis underwent a transjugular intrahepatic portosystemic shunt (TIPS) for refractory ascites. On the 9th day after the procedure, he presented with melena and decreasing hemoglobin levels. Hemobilia due to fistula formation between the right intrahepatic bile duct and right hepatic artery was suspected on computed tomography. Angiography revealed a fistula of the small branches of the hepatic segmental arteries, and right intrahepatic bile duct was confirmed; embolization was successfully performed with a coil for the eighth segmental hepatic artery, a glue-lipiodol mixture for the fifth segmental hepatic artery, and gelfoam slurry for the right anterior hepatic artery. However, 2 days after embolization, the patient died owing to aggravated disseminated intravascular coagulopathy. When gastrointestinal bleeding occurs after TIPS, careful evaluation is immediately required, and hemobilia should be considered.

46세 남자 환자가 알코올성 간경화와 동반된 지속되는 복수로 인해 경경정맥 간내 문맥 정맥 단락술을 시행 받았다. 시술 후 9일째 흑색변 및 헤모글로빈 수치의 감소로 혈관조영 컴퓨터 전산화단층촬영을 시행하였으며 혈액담즙증 및 우간동맥과 우간내담관 사이의 동맥-담관루가 의심되었다. 혈관조영술에서 분절간동맥의 작은 분지와 우간내담관의 동맥-담관루가 확인되었다. 분절8 간동맥에 대해 코일로, 분절5 간동맥에 대해 글루-리피오돌 혼합물로, 우전 간동맥에 대해 젤폼으로 색전술을 시행하였고, 시술 후 혈관조영술에서 동맥-담관루는 소실되었다. 그러나 색전술 시행 2일 후 환자는 진행하는 파종성 혈관 내 응고로 인해 사망하였다. 경경정맥 간내 문맥 정맥 단락술 이후 위장관 출혈이 있을 경우 혈액담즙증의 가능성을 반드시 고려하여 가능한 빠른 시기에 적절한 조치가 필요할 것이다.

Keywords

References

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