Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2022; 10(10): 3306-3312
Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3306
Endoscopic-catheter-directed infusion of diluted (-)-noradrenaline for atypical hemobilia caused by liver abscess: A case report
Hong Zou, Yi Wen, Yong Pang, Hui Zhang, Lin Zhang, Li-Jun Tang, Hong Wu
Hong Zou, Hong Wu, Department of Liver Surgery & Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610044, Sichuan Province, China
Yi Wen, Yong Pang, Hui Zhang, Lin Zhang, Li-Jun Tang, Department of General Surgery & Pancreatic Injury and Repair Key Laboratory of Sichuan Province, The General Hospital of Western Theater Command (Chengdu Military General Hospital), Chengdu 610083, Sichuan Province, China
Author contributions: Zou H and Wen Y participated in the writing of the main manuscript; Zou H and Zhang L led overall treatment; Pang Y and Wen Y led endoscopic treatment; Zhang H led ultrasound therapy; Zou H and Wen Y prepared all the figures; Wu H and Tang LJ participated in the revision of the manuscript and final approval.
Supported by the National Clinical Key Subject of China, No. 41732113.
Informed consent statement: Informed written consent was obtained from the patient’ parents for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong Wu, MD, PhD, Doctor, Professor, Surgeon, Department of Liver Surgery & Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, No. 37 Guoxue Lane, Wuhou District, Chengdu 610044, Sichuan Province, China.wuhong@scu.edu.cn
Received: November 24, 2021
Peer-review started: November 24, 2021
First decision: December 26, 2021
Revised: December 29, 2021
Accepted: February 15, 2022
Article in press: February 15, 2022
Published online: April 6, 2022
Abstract
BACKGROUND

Hemobilia occurs when there is a fistula between hepatic blood vessels and biliary radicles, and represents only a minority of upper gastrointestinal hemorrhages. Causes of hemobilia are varied, but liver abscess rarely causes hemobilia and only a few cases have been reported. Here, we present a case of atypical hemobilia caused by liver abscess that was successfully managed by endoscopic hepatobiliary intervention through endoscopic retrograde cholangiopancreatography (ERCP).

CASE SUMMARY

A 54-year-old man presented to our emergency department with a history of right upper quadrant abdominal colic and repeated fever for 6 d. Abdominal sonography and enhanced computed tomography revealed that there was an abscess in the right anterior lobe of the liver. During hospitalization, the patient developed upper gastrointestinal bleeding. Upper gastrointestinal endoscopy revealed a duodenal ulcer bleeding that was treated with three metal clamps. However, the hemodynamics was still unstable. Hence, upper gastrointestinal endoscopy was performed again and fresh blood was seen flowing from the ampulla of Vater. Selective angiography did not show any abnormality. An endoscopic nasobiliary drainage (ENBD) tube was inserted into the right anterior bile duct through ERCP, and subsequently cold saline containing (-)-noradrenaline was infused into the bile duct lumen through the ENBD tube with no episode of further bleeding.

CONCLUSION

Hemobilia should be considered in the development of liver abscess, and endoscopy is essential for diagnosis and management of some cases.

Keywords: Hemobilia, Liver abscess, Noradrenaline, Endoscopic retrograde cholangiopancreatography, Case report

Core Tip: Hemobilia occurs when there is a communication between intrahepatic blood vessels and biliary radicles caused by injury or some diseases, and represents only a minority of upper gastrointestinal hemorrhages. Liver abscess rarely causes hemobilia and only a few cases have been reported. Here, we present a rare case of atypical hemobilia caused by liver abscess that was successfully managed by catheter‐directed infusion of diluted (-)-noradrenaline with an endoscopic nasobiliary drainage tube.