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Case Report
 
A rare cause of upper gastrointestinal bleeding: Posttraumatic pseudoaneurysm
Negi RC1, Brij Sharma2, Bhupender3, Gaurav Kapoor3, Bal Beer Verma4, Ashok Sharma5
1Senior Resident, Department of Medicine and Gastroenterology, IGMC Shimla, HP, India.
2Assisstant Prof, Department of Medicine and Gastroenterology, IGMC Shimla, HP, India.
3Junior Resident, Department of Medicine and Gastroenterology, IGMC Shimla, HP, India.
4Associate Professor, Department of Medicine and Gastroenterology, IGMC Shimla, HP, India.
5Professor, Department of Medicine and Gastroenterology, IGMC Shimla, HP, India.

doi:10.5348/ijcri-201476-CR-10387

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Dr. Negi RC
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New Shimla, Shimla
Himachal Pradesh
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Fax: +911772670080
Email: rcnegi@yahoo.co.in

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How to cite this article
Negi RC, Sharma B, Bhupender, Kapoor G, Verma BB, Sharma A. A rare cause of upper gastrointestinal bleeding: Posttraumatic pseudoaneurysm. International Journal of Case Reports and Images 2014;5(5):387–390.


Abstract
Introduction: Hemobilia is a rare cause of upper gastrointestinal bleeding. It needs prompt diagnosis and immediate management to safe the life. Posttraumatic pseudoaneurysm of hepatic artery is seen mostly after abdominal trauma causing liver injury or interventions on hepatobiliary system. On esophagogastroduodenoscopy active bleeding without apparent source is clue to the diagnosis.
Case Report: A 27-year-old male presented with history of one episode of hematemesis and melena. There was history of roadside accident one and a half months before and he had liver injury which was revealed on computed tomography of the abdomen. Patient was managed conservatively and discharged. On examination, patients was anemic and had postural fall in blood pressure. Emergency esophagogastroduodenoscopy revealed blood coming from ampulla. Computed tomography angiography (CTA) revealed pseudoaneurysm in segmental branches of right hepatic artery with active bleeding.
Conclusion: Hemobilia is defined as bleeding into the biliary tree from abnormal communication between blood vessel and bile duct. The most common cause of posttraumatic hemobilia is pseudoaneurysm. The classic triad of hemobilia is absent in 70% of cases and in such cases clinical diagnosis is difficult. The CTA is the investigation of choice and embolization is the treatment option. Surgery should be done in cases refractory to embolization.

Keywords: Hemobilia, pseudoaneurysm, embolization, Gastrointestinal bleeding.


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Author Contributions
Negi RC – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Brij Sharma – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Bhupender – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Gaurav Kapoor – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Bal Beer Verma – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ashok Sharma – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2014 Negi RC et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.