Two distinct episodes of life-threatening hemobilia due to a lesion of common bile duct and delayed intrapancreatic arteriobiliary fistula managed by emergency pancreatoduodenal resection

Hemobilia is an extremely rare cause of upper gastrointestinal bleeding. It often has intermittent manifestation, which may lead to significant diagnostic delay. In 65% of the cases, the causes are iatrogenic, in 7% the cause is malignancy, in 5% - gallstones, in 8% it is inflammation (cholecystitis, parasites, reflux cholangitis), vascular abnormality is the cause in 7% (most commonly pseudoaneurysm of the hepatic artery), and pancreatic pseudocyst causes hemobilia in 1%. In almost all cases, the bleeding originates from intrahepatic or extrahepatic bile ducts, and rarely from the pancreas. PUBMED search with keywords “hemobilia” and “arteriobiliary fistula” found a total of 44 papers. No case with intrapancreatic arterio-biliary fistula was found. To the best of our knowledge, we present a unique case of delayed life-threatening hemobilia caused by intrapancreatic arterio-biliary fistula. It was diagnosed at the fourth admission and managed successfully by emergency Traverso-Longmire pancreatoduodenal resection. We briefly discuss the keys to a timely diagnosis and the cornerstones of the treatment. The timely diagnosis of hemobilia depends on a high index of suspicion and careful interpretation of the symptoms. Hemodynamic stability has a crucial role in the decision-making process. Angioembolization is the cornerstone of the treatment, whereas surgery is reserved only for cases with an unstable hemodynamic or unsuccessful embolization. Surgical approach depends on the bleeding site. Although an emergency pancreatic head resection is a procedure of last resort, it can be life-saving in cases with intractable bleeding due to intrapancreatic arteriobiliary fistula

Two distinct episodes of life-threatening hemobilia due to a lesion of common bile duct and delayed intrapancreatic arteriobiliary fistula managed by emergency pancreatoduodenal resection

Hemobilia is an extremely rare cause of upper gastrointestinal bleeding. It often has intermittent manifestation, which may lead to significant diagnostic delay. In 65% of the cases, the causes are iatrogenic, in 7% the cause is malignancy, in 5% - gallstones, in 8% it is inflammation (cholecystitis, parasites, reflux cholangitis), vascular abnormality is the cause in 7% (most commonly pseudoaneurysm of the hepatic artery), and pancreatic pseudocyst causes hemobilia in 1%. In almost all cases, the bleeding originates from intrahepatic or extrahepatic bile ducts, and rarely from the pancreas. PUBMED search with keywords “hemobilia” and “arteriobiliary fistula” found a total of 44 papers. No case with intrapancreatic arterio-biliary fistula was found. To the best of our knowledge, we present a unique case of delayed life-threatening hemobilia caused by intrapancreatic arterio-biliary fistula. It was diagnosed at the fourth admission and managed successfully by emergency Traverso-Longmire pancreatoduodenal resection. We briefly discuss the keys to a timely diagnosis and the cornerstones of the treatment. The timely diagnosis of hemobilia depends on a high index of suspicion and careful interpretation of the symptoms. Hemodynamic stability has a crucial role in the decision-making process. Angioembolization is the cornerstone of the treatment, whereas surgery is reserved only for cases with an unstable hemodynamic or unsuccessful embolization. Surgical approach depends on the bleeding site. Although an emergency pancreatic head resection is a procedure of last resort, it can be life-saving in cases with intractable bleeding due to intrapancreatic arteriobiliary fistula

In vitro Bioactivity of Polycaprolactone/Bioglass Composites

A series of Polycaprolactone and Bioglass in the 85SiO 2-10CaO-5P2O 5 (mol. %) systems were synthesized at different quantity of the organic/inorganic co mponents. The 85S Bioglass was prepared via sol-gel method. It was added to the Polycaprolactone matrix at 20, 50 and 80 weight (wt.) %, respectively. In vitro bioactivity of the prepared composites was evaluated in 1.5 Simu lated Body Flu id (1.5 SBF). The obtained composite materials before and after static in vitro test were characterized by FTIR and SEM. The obtained experimental data proved that the synthesized co mposites exhibit good in vitro bioactivity. After immersion in 1.5SBF, SEM depicts the presence of nano-needle-like hydro xyapatite on the immersed 20PCL/80BG and 50PCL/50BG samples