Transarterial Embolization and continuous Infusion of Pitressin for Massive Hemobilia in a Patient with Bile Duct Cancer

Kohei Noguchi, Hiroshi Tanimura, Hiroki Yamaue, Yoshihiro Sugimoto

Department of Gastroenterological Surgery, Wakayama Medical College

A 53-year-old man with jaundice was diagnosed with hepatic hilum cancer of the bile duct. He had tarry stool 13 days after PTCB performed for relief from jaundice. Emergency angiography confirmed the aneurysm at a branch of the right hepatic artery, and we embolized the right hepatic artery for massive hemobilia. Post-TAE angiography did not indicate hemorrhage, but his anemia progressed slowly, angiography performed on the next day again showed no massive hemobilia and showed the extravasation of contrast medium from a proximal branch of the right hepatic and the gastroduodenal arteries. TAE of the proper hepatic artery was attempted, and continuous intraarterial infusion of pitressin at the gastroduodenal artery was started. Subsequently, his physical condition improved without hemorrhage, and eventually hepatopancreaticoduodenectomy could be performed. Thus, it is concluded that TAE plus continuous intraarterial infusion of pitressin were usefull in the management of hemobilia due to bile duct cancer.

Key words
hemobilia, transarterial embolization, bile duct cancer

Reprint requests
Kohei Noguchi Department of Gastroenterological Surgery, Wakayama Medical College
Shichibancho-27, Wakayama, 640 JAPAN

Accepted
November 9, 1994

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