Hemobilia secondary to a transhepatic hemodialysis catheter: A rare complication

Abstract

Background: Hemobilia is an uncommon cause of upper gastrointestinal bleeding, usually of iatrogenic origin, and rarely associated with the use of transhepatic central venous catheters (TCVC) for hemodialysis, which makes its diagnosis and timely management challenging.

Purpose: Describe the clinical presentation, diagnosis, and management of a case of hemobilia secondary to the placement of a transhepatic central venous catheter for hemodialysis, with the aim of highlighting this rare complication.

Case presentation: A 43-year-old woman with chronic kidney disease on hemodialysis for 15 years, with multiple failed vascular accesses and large-vessel stenosis, required placement of a TCVC as a last resort. Three months later, she presented catheter dysfunction, abdominal pain, and melena during hemodialysis sessions. Computed tomography revealed hemocolecyst, confirmed by magnetic resonance cholangiography. Endoscopy performed during hemodialysis showed active bleeding and the presence of clots in the duodenal papilla, confirming the diagnosis of hemobilia. The patient was switched to peritoneal dialysis, and the TCVC was maintained in situ due to its possible tamponade effect. Nine months later, the TCVC was removed due to tunnel infection, without complications.

Conclusion: This case highlights hemobilia as a rare but relevant complication of transhepatic catheterization for hemodialysis. It underscores the importance of considering this diagnosis in cases of upper gastrointestinal bleeding in patients with recent hepatic procedures, and the need for individualized management.