Selective coil embolization of hepatic artery pseudoaneurysm causing hemobilia secondary to hemorrhagic hepatic hydatid cyst: A case report

Hemobilia secondary to intrabiliary rupture of a hepatic hydatid cyst is rare, and concomitant arterial pseudoaneurysm formation further increases the risk of life-threatening hemorrhage. Case: An 80-year-old woman presented with 3 months of melena, progressing to large-volume melena and hematemesis. She was hypotensive and severely anemic (hemoglobin 6.0 g/dL). Upper endoscopy revealed a clot at the sphincter of Oddi, consistent with hemobilia. Multiphase CT showed a right-lobe hydatid cyst with active intracystic arterial extravasation and communication with the biliary ducts, with additional right-lobe hydatid cysts. Angiography identified a pseudoaneurysm arising from a segment V branch of the right hepatic artery. Given the patient’s advanced age, hemodynamic instability, and high surgical risk, emergent selective endovascular embolization—rather than surgery—was chosen as first-line treatment, and superselective coil embolization achieved hemostasis. Post-procedure, hemoglobin improved to 10.6 g/dL by day 4; follow-up CT at day 4 demonstrated resolution of the pseudoaneurysm without rebleeding. Albendazole therapy was initiated after embolization. Echinococcus serology was not available, and reported follow-up was limited to 4 days; these are acknowledged as limitations. Conclusion: In elderly or hemodynamically unstable patients with hemorrhagic hydatid cyst and hemobilia, selective endovascular embolization can provide rapid, organ-preserving control of bleeding and a bridge to definitive antiparasitic management, although longer-term data are needed.