Introduction: Cholangiolithiasis with hemobilia is uncommon but potentially life-threatening, and challenging for surgeons to manage. Here we present a complex cholangiolithiasis case with hemobilia evaluated by endoscopic retrograde cholangiopancreatography (ERCP) was treated by liver transplantation(LT) and interventional emobolization successfully when he developed post-LT gastrointestinal bleeding(GI).
Case presentation: A-62-year-old male was admitted due to abdominal pain and jaundice. He had three past operations of appendectomy, cholecystectomy, and left lateral hepatectomy with bile duct exploration. Abdominal computed tomography scan revealed markedly dilated common bile duct(CBD) packed with stones and multiple intrahepatic stones(Fig.1). ERCP revealed hemobilia(Fig.2).

The hemobilia aggravated and he received emergent cadaveric LT two weeks after admission. During the operation, there were extensive intraabdominal adhesions, obvious hemobilia, markedly dilated CBD, 3cm, with numerous black stones. The recipient’s CBD was reshaped for bile duct reconstruction as the donor’s CBD was 6mm in diameter(Fig.3). The operation lasted for 7.5 hours. 2 weeks post-LT, he developed twice severe GI bleeding and emergent selective microcoils emobolization was performed to occlude the branch artery of gastroduodenal artery(GDA)(Fig.4), and communicating branch of superior mesenteric artery and GDA(Fig.5). The patient recovered well after interventional embolization. He developed mild biliary stricture later and was treated with stent by ERCP. He was discharged two-month post-LT and now lives well after 9 months’ follow up.

Conclusion: LT can be a rescue therapy to treat patients with complex bile duct stones and hemobilia. Interventional radiology is an urgent method to manage patients with artery-related GI bleeding.