Download PDF
Semin intervent Radiol 2016; 33(04): 324-331
DOI: 10.1055/s-0036-1592321
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hemobilia

Rakesh Navuluri
1   Department of Radiology, The University of Chicago, Chicago, Illinois
› Author Affiliations
Further Information

Publication History

Publication Date:
31 October 2016 (online)

Also available at
    Permissions and Reprints

Abstract

Hemobilia is a rare source of upper gastrointestinal bleeding, though the incidence is increasing along with the rise in minimally invasive biliary interventions. Prompt diagnosis and treatment rests on having appropriate clinical suspicion which should be based on the patient's presenting signs and symptoms, as well as history including recent instrumentation. Endoscopy should be reserved for cases of upper gastrointestinal bleeding with low suspicion for hemobilia. Interventional radiology may be the first-line diagnostic and therapeutic option for patients with a high suspicion of hemobilia. While embolization is the mainstay of therapy, other options include thrombin injection, stent placement, and/or placement of a percutaneous biliary drain. Surgery should be reserved for failed treatment by interventional radiology.

Keywords

hemobilia - imaging - interventional radiology - embolization
 

  • References

  • 1 Glisson. Anatomia Hepatis. London: O. Pullein; 1654
    PubMed
  • 2 Sandblom P. Hemorrhage into the biliary tract following trauma; traumatic hemobilia. Surgery 1948; 24 (3) 571-586
    PubMedSearch in Google Scholar
  • 3 Quinke H. Ein Fall von Aneurysma der Leberarterie. Klin Wochenschr 1871; 88: 773-786
    PubMedSearch in Google Scholar
  • 4 Murugesan SD, Sathyanesan J, Lakshmanan A , et al. Massive hemobilia: a diagnostic and therapeutic challenge. World J Surg 2014; 38 (7) 1755-1762
    CrossrefPubMedSearch in Google Scholar
  • 5 Green MH, Duell RM, Johnson CD, Jamieson NV. Haemobilia. Br J Surg 2001; 88 (6) 773-786
    CrossrefPubMedSearch in Google Scholar
  • 6 Goffette PP, Laterre PF. Traumatic injuries: imaging and intervention in post-traumatic complications (delayed intervention). Eur Radiol 2002; 12 (5) 994-1021
    CrossrefPubMedSearch in Google Scholar
  • 7 Lee SH, Hong SG, Lee KY , et al. Delayed severe hemobilia after endoscopic biliary plastic stent insertion. Clin Endosc 2016; 49 (3) 303-307
    CrossrefPubMedSearch in Google Scholar
  • 8 Mutignani M, Shah SK, Bruni A, Perri V, Costamagna G. Endoscopic treatment of extrahepatic bile duct strictures in patients with portal biliopathy carries a high risk of haemobilia: report of 3 cases. Dig Liver Dis 2002; 34 (8) 587-591
    CrossrefPubMedSearch in Google Scholar
  • 9 Hommes M, Kazemier G, van Dijk LC , et al. Complex liver trauma with bilhemia treated with perihepatic packing and endovascular stent in the vena cava. J Trauma 2009; 67 (2) E51-E53
    CrossrefPubMedSearch in Google Scholar
  • 10 Sandblom P. Hemobilia. Surg Clin North Am 1973; 53 (5) 1191-1201
    PubMedSearch in Google Scholar
  • 11 Madanur MA, Battula N, Sethi H, Deshpande R, Heaton N, Rela M. Pseudoaneurysm following laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int 2007; 6 (3) 294-298
    PubMedSearch in Google Scholar
  • 12 Rivera-Sanfeliz GM, Assar OS, LaBerge JM , et al. Incidence of important hemobilia following transhepatic biliary drainage: left-sided versus right-sided approaches. Cardiovasc Intervent Radiol 2004; 27 (2) 137-139
    PubMedSearch in Google Scholar
  • 13 Fidelman N, Bloom AI, Kerlan Jr RK , et al. Hepatic arterial injuries after percutaneous biliary interventions in the era of laparoscopic surgery and liver transplantation: experience with 930 patients. Radiology 2008; 247 (3) 880-886
    CrossrefPubMedSearch in Google Scholar
  • 14 Gandhi V, Doctor N, Marar S, Nagral A, Nagral S. Major hemobilia—experience from a specialist unit in a developing country. Trop Gastroenterol 2011; 32 (3) 214-218
    PubMedSearch in Google Scholar
  • 15 Zhou HB. Hemobilia and other complications caused by percutaneous ultrasound-guided liver biopsy. World J Gastroenterol 2014; 20 (13) 3712-3715
    CrossrefPubMedSearch in Google Scholar
  • 16 Gurakuqi GC, Stadlbauer V, Portugaller HR, Högenauer C, Trauner M, Stauber RE. Fatal hemobilia resulting from an iatrogenic arteriobiliary fistula as a rare complication of transjugular liver biopsy. Eur J Gastroenterol Hepatol 2008; 20 (1) 83-86
    CrossrefPubMedSearch in Google Scholar
  • 17 Balsara KP, Dubash C, Shah CR. Pseudoaneurysm of the hepatic artery along with common bile duct injury following laparoscopic cholecystectomy. A report of two cases. Surg Endosc 1998; 12 (3) 276-277
    CrossrefPubMedSearch in Google Scholar
  • 18 Kim KH, Kim TN. Etiology, clinical features, and endoscopic management of hemobilia: a retrospective analysis of 37 cases. Korean J Gastroenterol 2012; 59 (4) 296-302
    CrossrefPubMedSearch in Google Scholar
  • 19 Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol 2012; 107 (3) 345-360 , quiz 361
    CrossrefPubMedSearch in Google Scholar
  • 20 Bloechle C, Izbicki JR, Rashed MY , et al. Hemobilia: presentation, diagnosis, and management. Am J Gastroenterol 1994; 89 (9) 1537-1540
    PubMedSearch in Google Scholar
  • 21 Tobben PJ, Zajko AB, Sumkin JH , et al. Pseudoaneurysms complicating organ transplantation: roles of CT, duplex sonography, and angiography. Radiology 1988; 169 (1) 65-70
    CrossrefPubMedSearch in Google Scholar
  • 22 Srivastava DN, Sharma S, Pal S , et al. Transcatheter arterial embolization in the management of hemobilia. Abdom Imaging 2006; 31 (4) 439-448
    CrossrefPubMedSearch in Google Scholar
  • 23 Cagli B, Tuncel SA, Sengul E , et al. Hemobilia and occult cystic artery stump bleeding after a laparoscopic cholecystectomy: endovascular treatment with N-butyl cyanoacrylate. Prague Med Rep 2011; 112 (2) 132-136
    PubMedSearch in Google Scholar
  • 24 Krokidis ME, Hatzidakis AA. Acute hemobilia after bilioplasty due to hepatic artery pseudoaneurysm: treatment with an ePTFE-covered stent. Cardiovasc Intervent Radiol 2009; 32 (3) 605-607
    CrossrefPubMedSearch in Google Scholar
  • 25 Hardman RL, Taussky P, Kim R, O'Hara RG. Post-transplant hepatic artery pseudoaneurysm treated with the pipeline flow-diverting stent. Cardiovasc Intervent Radiol 2015; 38 (4) 1043-1046
    CrossrefPubMedSearch in Google Scholar
  • 26 Krueger K, Zaehringer M, Strohe D, Stuetzer H, Boecker J, Lackner K. Postcatheterization pseudoaneurysm: results of US-guided percutaneous thrombin injection in 240 patients. Radiology 2005; 236 (3) 1104-1110
    CrossrefPubMedSearch in Google Scholar
  • 27 Lorenz JM, van Beek D, Van Ha TG, Lai J, Funaki B. Percutaneous thrombin injection in an infant to treat hepatic artery pseudoaneurysm after failed embolization. Pediatr Radiol 2013; 43 (11) 1532-1535
    CrossrefPubMedSearch in Google Scholar
  • 28 Francisco LE, Asunción LC, Antonio CA, Ricardo RC, Manuel RP, Caridad MH. Post-traumatic hepatic artery pseudoaneurysm treated with endovascular embolization and thrombin injection. World J Hepatol 2010; 2 (2) 87-90
    PubMedSearch in Google Scholar
  • 29 Schuster R, Broumandi DD, Lee AA, Waxman K. Percutaneous thrombin injection to treat a post-traumatic hepatic pseudoaneurysm. J Trauma 2005; 59 (4) 1022-1024
    CrossrefPubMedSearch in Google Scholar
  • 30 Albuquerque W, Arantes V, de Paula Farah K, Lambertucci JR. Acute pancreatitis and acute cholecystitis caused by hemobilia after percutaneous ultrasound-guided liver biopsy. Endoscopy 2005; 37 (11) 1159-1160
    Thieme ConnectPubMedSearch in Google Scholar
  • 31 Chin MW, Enns R. Hemobilia. Curr Gastroenterol Rep 2010; 12 (2) 121-129
    CrossrefPubMedSearch in Google Scholar
  • 32 Edden Y, St Hilaire H, Benkov K, Harris MT. Percutaneous liver biopsy complicated by hemobilia-associated acute cholecystitis. World J Gastroenterol 2006; 12 (27) 4435-4436
    CrossrefPubMedSearch in Google Scholar