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ERCP image: post stents with no fistulous connection.
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There were no immediate complications following the ERCP with no evidence of fistulous connection on fluoroscopy image(Fig. 1).
Hemobilia: endoscopic image of active bleeding from ampulla.
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Eventually on one of the episodes of large volume hematemesis with hypotension requiring large volume transfusion and intubation; on upper endoscopy active hemobilia was visualized (Fig. 2).
Areteriobiliary fistula: fistula between R hepatic artery and common hepatic duct.
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An emergent catheter guided mesenteric angiogram noted Ateriobiliary fistula between R hepatic artery and common hepatic duct (Fig. 3), transcatheter coil/Gelfoam slurry embolization of the right hepatic artery was done (Fig. 4).
Post coil: successful closure of fistula with no arterial contrast flow into common hepatic duct.
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Post-embolization angiogram shows closure of fistula (Fig. 5), hematemesis resolved following the procedure.