Life-threating bleeding after cholecysto-gastrostomy

Case and findings: A 76-year-old woman with a biliary self-expandable metal stent due to ampulloma for 2 years, was admitted to hospital for acute cholecystitis. Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with a cholecysto-gastrostomy was performed using a 15x10 mm Hot-Axios lumen-apposing metal stent (LAMS). In recovery area, the patient presented hypotension, bradycardia and abdominal pain with no signs of peritonitis and without response to hydroelectric replacement. On suspicion of internal bleeding, a CT scan was performed confirming an active bleeding of the gallbladder wall to peritoneum. An emergent cholecystectomy was performed, and hemoperitoneum was found due to a bleeding vessel from the posterior wall of gallbladder at the site of LAMS. The patient was discharged 7 days after surgery [1] [2] [3] [4] [5] [6] [7] [8] [9].

Key points: The most common complications reported with EUS-GBD are bleeding, stent misdeployment, perforation, pneumoperitoneum, bile leak, buried stent, and stent occlusion. Most such events can effectively be treated endoscopically. Severe acute bleeding is rarely described, and it is usually self-limiting due to the tamponade effect of the LAMS itself. The presence of aberrant vessels around the gallbladder wall due to malignant aetiology could have been the cause of the bleeding. It is mandatory to monitor the patient’s vital signs after the procedure, as well as perform a CT scan in case of suspected complications. Although severe early bleeding from EUS-GBD is not a common adverse event, it is important to keep in mind due the possibility of a life-threatening situation

Publication History

Article published online:
27 March 2025

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