|Hemorrhage after papillotomy
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.
After evacuation of the blood
the bleeding site can be
localized to the papilla´s roof.
An active oozing hemorrhage
can be seen.
The hemorrhage is treated by
of adrenalin (dilution 1:20000).
The close-up reveals a big vessel above
the needle- catheter.
The cause of the
colic attacks is
identified by filling defects on
radiographs, possibly representing
clots in the ductular lumen.
Biliary lavage is performed for
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
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.