Endoscopic insertion of a plastic biliary stent is a common procedure in patients with choledocholithiasis, biliary stricture, and biliary tumors [1,2,3,4]. Procedure-related complications including cholangitis, pancreatitis, hemobilia, perforation of the bile duct and duodenum, and stent migration have been reported [1,2,3,4,5]. Hepatic artery pseudoaneurysm (HAP) formation is a very rare complication, but it can cause hemobilia [6,7,8,9,10,11,12,13,14]. HAP is reported to occur in 1.2% of cases after metal stent placement for malignant biliary obstruction [10]. However, it is an infrequent complication after plastic stent placement for benign biliary disease, and the risk factors include long-standing catheter placement, severe cholangitis, liver abscess, and long-term steroid use [8,9,10,11,12,13,14,15].

Prophylactic and therapeutic transarterial embolization for HAP is beneficial procedure [16]. Asymptomatic patients with HAP are also recommended to be treated because of the associated high risk of rupture [17]. Embolization should be limited to pseudoaneurysms because excessive ischemia of the surrounding liver parenchyma can cause liver abscesses in patients with endoscopic biliary drainage [18].

Here, we report the case of a patient with transient hemobilia caused by HAP following plastic biliary stent insertion, who was successfully treated with selective transarterial embolization.