A Critical Case Report of Delayed Massive Hemorrhage after Percutaneous Transhepatic Gallbladder Puncture and Drainage

Background: Percutaneous transhepatic gallbladder puncture and drainage (PTGD) plays a critical role in controlling biliary tract infections. However, this procedure may also be associated with significant complications, such as major hemorrhage resulting from inadvertent puncture of hepatic artery branches along the needle trajectory. Case presentation: Recently, we encountered a case of a patient with acute calculous cholecystitis who was admitted to our department. Given the severity of the infection, initial management included PTGD. After one month of adequate drainage, the patient underwent definitive surgical intervention, during which the drainage catheter was removed without evidence of bleeding. Nevertheless, one week postoperatively, the patient experienced sudden massive hematemesis of bright red blood from the surgical site drainage tube. Angiography confirmed active bleeding originating from a branch of the middle hepatic artery located along the previous gallbladder puncture path. Interventional embolization therapy was promptly performed, successfully achieving hemostasis. Following recovery, the patient was discharged in stable condition. Conclusion: Meticulous planning of the puncture pathway is essential to avoid both major and minor branches of the hepatic pedicle. In cases where hepatic pedicle injury is suspected, vigilant monitoring of the patient's condition is warranted. Prompt angiography and embolization should be performed upon identification of intrahepatic arterial bleeding to achieve hemostasis.