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.