Delayed Bleeding After Endoscopic Ultrasound-guided Hepaticogastrostomy due to Pseudoaneurysm Rupture in a Patient Who Underwent Plastic Stent Placement: A Case Report

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is a useful alternative treatment for endoscopic retrograde cholangiopancreatography (ERCP) failure. However, serious complications sometimes occur. Bleeding is an early complication that occurs during puncture; however, there have been some reports of late-onset rupture of a pseudoaneurysm. These reports describe cases of patients who underwent metal stent placement. Herein, we report the first case of pseudoaneurysm formation after plastic stent placement via EUS-HGS. The patient was a 75-year-old man with obstructive jaundice due to pancreatic head cancer. ERCP was unsuccessful, and EUS-HGS was performed with plastic stent placement from B3. The patient subsequently experienced repeated HGS stent failure within a short period, and the plastic stent was replaced each time. No metal stents were placed during treatment. 106 days after EUS-HGS, the patient presented with hematochezia and shock, and contrast-enhanced computed tomography suggested the rupture of a pseudoaneurysm in the left hepatic artery branch. Emergency angiography revealed that the pseudoaneurysm originated from the A2+3 branch of the left hepatic artery, and embolization was performed. Subsequently, there has been no recurrence of bleeding, and the patient was eligible for chemotherapy to treat pancreatic cancer.