Delayed bleeding with a pseudoaneurysm after EUS-guided hepaticogastrostomy

A 93-year-old man who had undergone distal gastrectomy with Billroth II reconstruction was admitted with calculous cholangitis complicated by septic shock. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) was performed using a 7-Fr plastic stent. As bleeding was observed via the endosonographically created route on day 14, a self-expandable metallic stent (SEMS) was placed. On day 59, the patient was re-admitted for cholangitis and hematemesis. Emergency endoscopy revealed hemobilia in the SEMS and a large hematoma in the stomach; therefore, endoscopic nasobiliary drainage was performed. As contrast-enhanced computed tomography revealed an aneurysm adjacent to the SEMS, transarterial embolization was performed. Here, we report a rare case of delayed bleeding with a pseudoaneurysm after EUS-HGS.