Surgical control of life-threatening post-ERCP bleeding with a gelatin matrix-thrombin hemostatic agent

Dimitrios Dimitroulis; Efstathios Antoniou; Nikolaos P Karidis; Konstantinos Kontzoglou; Gregory Kouraklis

doi:10.1016/j.ijscr.2012.05.014

Surgical control of life-threatening post-ERCP bleeding with a gelatin matrix-thrombin hemostatic agent

Int J Surg Case Rep. 2012;3(9):471-3. doi: 10.1016/j.ijscr.2012.05.014. Epub 2012 Jun 2.

Authors

Dimitrios Dimitroulis¹, Efstathios Antoniou, Nikolaos P Karidis, Konstantinos Kontzoglou, Gregory Kouraklis

Affiliation

¹ Second Department of Surgery, Medical School, University of Athens, General Hospital Laiko, Athens, Greece.

Abstract

Introduction: Several conventional techniques have been developed in order to control surgical bleeding. Their greatest disadvantage, though, is their inability to control bleeding in areas where access is very difficult. In such cases the application of topical hemostatic agents may prove particularly useful.

Presentation of case: We describe the case of an 82-year old patient with life-threatening post-ERCP bleeding which was intraoperatively controlled with infusion of a topical gelatin matrix-thrombin hemostatic agent into the distal portion of the common bile duct.

Discussion: Most iatrogenic cases of post-ERCP bleeding occur at the site of sphincterotomy at the level of the ampulla of Vater and may be relatively easily controlled by repeat endoscopy and local hemostatic measures. More rarely, however, significant and difficult to control bleeding may occur within the lower portion of the common bile duct (CBD) where routine hemostatic techniques may prove unsuccessful. Under these circumstances, we successfully employed a novel hemostatic technique using a gelatin matrix-thrombin agent in a patient with life-threatening bleeding after ERCP.

Conclusion: This novel technique might prove particularly useful for bleeding control in surgically challenging anatomical areas such as the lower portion of the CBD.