P4248 - A Rare Cause of GI Bleed - Hepatic Artery Pseudoaneurysm Following ERCP: A Case Report

Divya Shivakumar, MBBS¹, Fahad Chaudhary, MBBS, MD¹, Greeshma Gaddipati, MBBS², Vivek Rathod, MBBS, DM¹, Ashok Busi, MBBS, MD¹, Anjani Dhannapuneni, MBBS, MD^1
1Kamineni Academy of Medical Sciences and Research Center, Hyderabad, Telangana, India; ²MedStar Union Memorial Hospital, Baltimore, MD

Introduction: Surgical operations such as laparoscopic cholecystectomy, orthoptic liver transplant, blunt abdominal trauma, liver biopsy, and iatrogenic liver parenchyma surgeries might result in hepatic artery pseudoaneurysm, a rare but serious complication.

Case Description/Methods: This case report describes a 41-year-old male who presented with a life-threatening gastrointestinal bleed which manifested as hematochezia where the patient had hypotension, tachycardia, and need for ionotropic support. The patient had a history of hydatid cyst which was causing jaundice for which CBD stenting was done before cyst excision. The patient underwent successful cyst excision 6 months before this bleeding episode. Subsequently, the patient underwent endoscopic stent removal during which there was blood oozing from the ampulla, indicating hemobilia. A CT angiography confirmed a right hepatic artery pseudoaneurysm. The patient was successfully treated with an interventional radiological procedure involving coiling and glue embolization of the right hepatic artery which stopped any further bleeding and the patient was stabilized.

Discussion: Though uncommon, visceral artery pseudoaneurysms should be taken into account in patients experiencing non-specific gastrointestinal bleeding, particularly following cholecystectomy, ERCP, liver transplants, or other hepatic parenchymal operations. In handling such issues, this example emphasizes the value of timely radiological diagnosis and intervention.



Disclosures:


Divya Shivakumar, MBBS¹, Fahad Chaudhary, MBBS, MD¹, Greeshma Gaddipati, MBBS², Vivek Rathod, MBBS, DM¹, Ashok Busi, MBBS, MD¹, Anjani Dhannapuneni, MBBS, MD¹. P4248 - A Rare Cause of GI Bleed - Hepatic Artery Pseudoaneurysm Following ERCP: A Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.