Endovascular embolization of a biliary–digestive loop bleeding

Delayed massive hemorrhage after biliary surgery is a severe complication and carries a high mortality rate. Upper gastrointestinal (GI) tract bleeding is usually managed endoscopically. However, the presence of altered anatomy following hepato-biliary surgery does preclude endoscopic exploration of the anastomoted loop. In our case of hemorrhage from biliodigestive anastomosis, CT angiography provides accurate information about the presence of active bleeding and its source. We present a case of bleeding from a biliary–digestive loop. The patient exhibited several bleeding risk factors, notably cirrhosis and dual antiplatelet therapy. Furthermore, the site of bleeding, the biliarydigestive loop, had experienced a fistula with a hepatic abscess 2 years earlier, following percutaneous thermoablation. Endovascular embolization with microparticles 300–500 µm and one microcoil 2mx4cm proved to be a safe and effective treatment in this high-risk patient with persistent bleeding. Developments in interventional radiology equipment and techniques, such as low-profile catheter systems and advanced embolic agents, validate embolization as a suitable therapeutic option.