| Hemorrhage after papillotomy |
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EPT was performed for symptomatic
obstructive jaandice with a history of
cholecystectomy. Severe colic
developed three days after EPT and
stone extraction. Endoscopic
evaluation reveals a massive
hemorrhage in the middle part of the
duodenum. The papilla is covered by
a big sentinal clot.
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After evacuation of the blood
the bleeding site can be
localized to the papilla´s roof.
An active oozing hemorrhage
can be seen.
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The hemorrhage is treated by
injection
of adrenalin (dilution 1:20000).
The close-up reveals a big vessel above
the needle- catheter.
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The cause of the
colic attacks is
identified by filling defects on
radiographs, possibly representing
clots in the ductular lumen.
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Biliary lavage is performed for
suspected
hemobilia. It produces considerable
amounts of blood and blood-clots. |
To facilitate biliary
flow a long biliary
stent is deployed. A second bleeding
the following day is treated by salvage
fibrin injection. Complete and long
lasting hemostasis is achieved by
means of this compoand. The picture
shows a second look two days after
fibrin application.
Even small papillotomies carry the risk
of a late hemorrhage, especially if the
roof of the papilla habours an arterial
vessel, like it is shown by the example.
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