Dark green urine following endoscopic ultrasound-guided hepaticogastrostomy: A case report

doi:10.3748/wjg.v31.i34.109900

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World Journal of Gastroenterology

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1007-9327

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Case Report

World J Gastroenterol. Sep 14, 2025; 31(34): 109900
Published online Sep 14, 2025. doi: 10.3748/wjg.v31.i34.109900

Dark green urine following endoscopic ultrasound-guided hepaticogastrostomy: A case report

Ke-Yi Zhang, Qi He, Yu Jin, Jun Liu, Rong Lin, Chao-Qun Han

Ke-Yi Zhang, Qi He, Yu Jin, Jun Liu, Rong Lin, Chao-Qun Han, Department of Gastroenterology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China

Co-corresponding authors: Rong Lin and Chao-Qun Han.

Author contributions: Zhang KY made conceptualization and visualization; Zhang KY, He Q, Jin Y, and Liu J wrote the original draft; Han CQ conducted resources and supervised; Han CQ and Lin R wrote and reviewed the work, they contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.

Supported by the National Key Research and Development Program, No. 2023YFC2307001; and the National Natural Science Foundation of China, No. 82170570, No. 82270698, and No. 82470679.

Informed consent statement: Informed consent was obtained from all subjects involved in the study.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Chao-Qun Han, Department of Gastroenterology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. hcq1987912@hotmail.com

Received: May 26, 2025
Revised: June 30, 2025
Accepted: August 13, 2025
Published online: September 14, 2025
Processing time: 103 Days and 20.3 Hours

Abstract

BACKGROUND

Endoscopic ultrasound-guided biliary drainage, including endoscopic ultrasound-guided choledochoduodenostomy and endoscopic ultrasound-guided hepatogastrostomy (EUS-HGS), is an efficacious alternative to endoscopic retrograde cholangiopancreatography and its common complications are bile leak, infection, stent migration and bleeding. Here, we report an atypical case of a patient who developed unexplained dark green urine after receiving EUS-HGS, which we suspected to be caused by an abnormal biliary-vascular fistula.

CASE SUMMARY

A 76-year-old woman diagnosed with pancreatic adenocarcinoma received EUS-HGS for relieving jaundice. The patient reported abdominal pain and chest tightness after the operation, with difficulty in urinating. X-ray suggested right-sided pleural effusion and dark green pleural effusion was drained out. However, the patient also developed dark green urine, which appeared everyday afternoon and disappeared automatically after intravenous treatment. The previous pleural effusion disappeared after one week, but later the patient showed an increase of ascites, and the lesions were compartmentalized and encapsulated internally.

CONCLUSION

Postoperative surveillance after EUS-HGS must be emphasized to check for in order to prevent severe and hidden complications.

Keywords: Pancreatic cancer; Duodenal obstruction; Endoscopic ultrasound-guided hepaticogastrostomy; Complication; Biliary leak; Pleural effusion; Urine color; Case report

Core Tip: This case report focused on unexplained urinary changes following endoscopic ultrasound-guided hepatogastrostomy. The patient developed unexplained dark green urine, which periodically appeared every morning and disappeared every afternoon after intravenous treatment. This phenomenon is highly intriguing and unexplainable, and calls for more attention to the complications of endoscopic ultrasound-guided biliary drainage (EUS-BD). Despite a high clinical success rate, EUS-BD may still be associated with adverse effects in one-seventh of the cases. Therefore, postoperative surveillance after EUS-BD must be emphasized.