S3419 Beyond the Vessels: An Atypical Case of Takayasu Arteritis With Pancreatic Involvement

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Introduction: Migration of a vascular coil into the common bile duct (CBD) following embolization of the hepatic artery is a rare complication that has not been frequently reported in the literature. Furthermore, when reported, it typically causes hemorrhage or cholangitis. Here we present a case where migration of the coil into the CBD led to liver abscess and cholestasis. Case Description/Methods: A 41-year-old woman with past medical history of cholecystectomy 9 years ago, complicated by bile leak and hemobilia requiring coiling of the hepatic artery in the same year, presented with 5 days of subjective fever, chills, diffuse abdominal pain, nausea, and vomiting. The patient has previously undergone multiple endoscopic retrograde cholangiopancreatographies (ERCP)s with stent placement and stone removal with the most recent 4 years ago. Initial labs demonstrated leukocytosis and computed tomography demonstrated diffuse intra and extrahepatic biliary ductal dilatation, migration of the coil into the CBD, and multiple fluid lesions suspicious for liver abscesses. ERCP confirmed an endovascular coil that had migrated to the distal CBD, a partial coil in the right intrahepatic bile duct, multiple stones, and pus seen in the papilla. The coil in the CBD was retrieved using Spyglass and the partial coil was left in place due to technical difficulty. The biliary tree was swept and a metal biliary stent was placed in the CBD and a plastic stent was placed in the right hepatic duct. The patient was then returned to the hospital ward where antibiotics were continued. Follow up ERCP was planned for 6 weeks later for a second attempt to remove the partial coil. Discussion: The common complication of stent migration based on literature is hemorrhage and cholangitis whereas our patient presented with liver abscess and cholestasis. While some studies have noted liver abscess as a complication of hepatic artery embolization, these patients had high-grade liver trauma and developed the abscess acutely after embolization compared to our patient who developed an abscess 9 years after embolization.

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