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Current Gastroenterology Reports
Published in: Current Gastroenterology Reports 2/2010

01-04-2010

Hemobilia

Authors: Marcus W. Chin, Robert Enns

Published in: Current Gastroenterology Reports | Issue 2/2010

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Abstract

Hemobilia is an uncommon medical problem that presents in a varied fashion and is increasingly of iatrogenic origin. The diagnosis of hemobilia needs to be considered in patients presenting with upper gastrointestinal bleeding, particularly if they are jaundiced with abdominal pain in the setting of recent or previous percutaneous liver intervention or abdominal trauma. Multislice computed tomographic angiography is increasingly being used in the investigation, but transcatheter arterial embolization remains the cornerstone of managing those patients requiring intervention. The majority of patients with hemobilia will be managed supportively or with radiologic intervention; most do not require surgical intervention.
Literature
1.
Glisson F: Anatomia Hepatis. London: O Pullein; 1654.
2.
Sandblom P: Hemorrhage into the biliary tract following trauma; traumatic hemobilia. Surgery 1948, 24:571–586.PubMed
3.
Quincke H: Ein fall von aneurysma der leberarterie. Berl Klein Wochenschr 1871, 30:349–352.
4.
Yoshida J, Donahue PE, Nyhus LM: Hemobilia: review of recent experience with a worldwide problem. Am J Gastroenterol 1987, 82:448–453.PubMed
5.
6.
7.
Wagner WH, Lundell CJ, Donovan AJ: Percutaneous angiographic embolization for hepatic arterial hemorrhage. Arch Surg 1985, 120:1241–1249.PubMed
8.
Sandblom P: Hemobilia (Biliary Tract Hemorrhage): History, Diagnosis, and Treatment. Springfield, IL: Charles C Thomas; 1972.
9.
Stewart DL, Torma MJ, Meyer GW: Pancreatic retention cyst secondary to chronic pancreatitis. A cause of hemobilia. Am J Dig Dis 1978, 23:663–666.CrossRefPubMed
10.
Luzuy F, Reinberg O, Kauszlaric D, et al.: Biliary calculi caused by hemobilia. Surgery 1987, 102:886–889.PubMed
11.
Mutignani M, Shah SK, Bruni A, et al.: 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, 34:587–591.CrossRefPubMed
12.
Ahn J, Trost DW, Mitty HA, Sos TA: Pseudoaneurysm formation after catheter dissection of the common hepatic artery: report of two cases. Am J Gastroenterol 1997, 92:696–699.PubMed
13.
Albuquerque W, Arantes V, de Paula FK, Lambertucci JR: Acute pancreatitis and acute cholecystitis caused by hemobilia after percutaneous ultrasound-guided liver biopsy. Endoscopy 2005, 37:1159–1160.CrossRefPubMed
14.
Asselah T, Condat B, Sibert A, et al.: Haemobilia causing acute pancreatitis after percutaneous liver biopsy: diagnosis by magnetic resonance cholangiopancreatography. Eur J Gastroenterol Hepatol 2001, 13:877–879.CrossRefPubMed
15.
Attiyeh FF, McSweeney J, Fortner JG: Hemobilia complicating needle liver biopsy: a case report with arteriographic demonstration. Radiology 1976, 118:559–560.PubMed
16.
Bergmann OM, Sun S, Weydert J, Silverman WB: Intrahepatic trifistula causing bilhemia and hemobilia resulting from transjugular liver biopsy in the setting of biliary tract obstruction (with video). Gastrointest Endosc 2007, 66:848–850.CrossRefPubMed
17.
Bichile LS, Malkan G, Patel YS, et al.: Recurrent haemobilia in a patient with polyarteritis nodosa. J Assoc Physicians India 1996, 44:49–50.PubMed
18.
de Quinta FR, Moles ML, Docobo DF, et al.: Hemobilia secondary to chronic cholecystitis. Rev Esp Enferm Dig 2004, 96:221–225.
19.
de Sio I, Castellano L, Calandra M: Hemobilia following percutaneous ethanol injection for hepatocellular carcinoma in a cirrhotic patient. J Clin Ultrasound 1992, 20:621–623.CrossRefPubMed
20.
Edden Y, St Hilaire H, Benkov K, Harris MT: Percutaneous liver biopsy complicated by hemobilia-associated acute cholecystitis. World J Gastroenterol 2006, 12:4435–4436.PubMed
21.
Enne M, Pacheco-Moreira LF, Cerqueira A, et al.: Fatal hemobilia after radiofrequency thermal ablation for hepatocellular carcinoma. Surgery 2004, 135:460–461.CrossRefPubMed
22.
Forlee MV, Krige JE, Welman CJ, Beningfield SJ: Haemobilia after penetrating and blunt liver injury: treatment with selective hepatic artery embolisation. Injury 2004, 35:23–28.CrossRefPubMed
23.
• Green MH, Duell RM, Johnson CD, Jamieson NV: Haemobilia. Br J Surg 2001, 88:773–786. This article is noteworthy because it is the most recent review of hemobilia in the literature. It highlights the increase in percutaneous transhepatic procedures as the leading etiology of hemobilia, compared with trauma, which was traditionally the leading cause. It also suggests that the majority of iatrogenic hemobilia can be managed conservatively.CrossRefPubMed
24.
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, 27:137–139.CrossRefPubMed
25.
Piccinino F, Sagnelli E, Pasquale G, Giusti G: Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J Hepatol 1986, 2:165–173.CrossRefPubMed
26.
Gurakuqi GC, Stadlbauer V, Portugaller HR, et al.: Fatal hemobilia resulting from an iatrogenic arteriobiliary fistula as a rare complication of transjugular liver biopsy. Eur J Gastroenterol Hepatol 2008, 20:83–86.CrossRefPubMed
27.
• Fidelman N, Bloom AI, Kerlan RK Jr, et al.: Hepatic arterial injuries after percutaneous biliary interventions in the era of laparoscopic surgery and liver transplantation: experience with 930 patients. Radiology 2008, 247:880–886. This article is a retrospective review of percutaneous biliary intervention at one center suggesting that the rate of arterial injury is lowest for PTC (0.7%) and increases to 2.6% with PTBD.CrossRefPubMed
28.
Monden M, Okamura J, Kobayashi N, et al.: Hemobilia after percutaneous transhepatic biliary drainage. Arch Surg 1980, 115:161–164.PubMed
29.
Burke DR, Lewis CA, Cardella JF, et al.: Quality improvement guidelines for percutaneous transhepatic cholangiography and biliary drainage. J Vasc Interv Radiol 2003, 14:S243–S246.PubMed
30.
Goodwin SC, Stainken BF, McNamara TO, Yoon HC: Prevention of significant hemobilia during placement of transhepatic biliary drainage catheters: technique modification and initial results. J Vasc Interv Radiol 1995, 6:229–232.CrossRefPubMed
31.
Goodwin SC, Bansal V, Greaser LE, et al.: Prevention of hemobilia during percutaneous biliary drainage: long-term follow-up. J Vasc Interv Radiol 1997, 8:881–883.CrossRefPubMed
32.
Mori K, Murata S, Yoshioka H, et al.: Transcatheter embolization of celiac artery pseudoaneurysm following pancreatico-duodenectomy for pancreatic cancer. A case report. Acta Radiologica 1998, 39:690–692.CrossRefPubMed
33.
Narasimharao KL, Narasimhan KL, Nagi B, et al.: Hemobilia due to ruptured hepatic artery aneurysm. Indian Pediatr 1988, 25:292–294.PubMed
34.
Park JY, Ryu H, Bang S, et al.: Hepatic artery pseudoaneurysm associated with plastic biliary stent. Yonsei Med J 2007, 48:546–548.CrossRefPubMed
35.
Ribeiro A, Williams H, May G, et al.: Hemobilia due to hepatic artery pseudoaneurysm thirteen months after laparoscopic cholecystectomy. J Clin Gastroenterol 1998, 26:50–53.CrossRefPubMed
36.
Saldinger PF, Wang JY, Boyd C, Lang E: Cystic artery stump pseudoaneurysm following laparoscopic cholecystectomy. Surgery 2002, 131:585–586.CrossRefPubMed
37.
Siablis D, Papathanassiou ZG, Karnabatidis D, et al.: Hemobilia secondary to hepatic artery pseudoaneurysm: an unusual complication of bile leakage in a patient with a history of a resected IIIb Klatskin tumor. World J Gastroenterol 2005, 11: 5229–5231.PubMed
38.
Srivastava DN, Chakravarti AL, Gupta RK, Gujral RB: Gastrointestinal bleeding from a false aneurysm of the hepatic artery after cholecystectomy. Am J Gastroenterol 1996, 91:395–397.PubMed
39.
Stauffer JT, Weinman MD, Bynum TE: Hemobilia in a patient with multiple hepatic artery aneurysms: a case report and review of the literature. Am J Gastroenterol 1989, 84:59–62.PubMed
40.
Strickland SK, Khoury MB, Kiproff PM, Raves JJ: Cystic artery pseudoaneurysm: a rare cause of hemobilia. Cardiovasc Intervent Radiol 1991, 14:183–184.CrossRefPubMed
41.
Thomas WE, May RE: Hepatic artery aneurysm following cholecystectomy. Postgrad Med J 1981, 57:393–395.CrossRefPubMed
42.
Zilberstein B, Cecconello I, Ramos AC, et al.: Hemobilia as a complication of laparoscopic cholecystectomy. Surg Laparosc Endosc 1994, 4:301–303.PubMed
43.
Leonardi LS, Soares C Jr, Boin IF, Oliveira VC: Hemobilia after mycotic hepatic artery pseudoaneurysm after liver transplantation. Transplant Proc 2001, 33:2580–2582.CrossRefPubMed
44.
Londono MC, Balderramo D, Cardenas A: Management of biliary complications after orthotopic liver transplantation: the role of endoscopy. World J Gastroenterol 2008, 14:493–497.CrossRefPubMed
45.
Lowell JA, Coopersmith CM, Shenoy S, Howard TK: Unusual presentations of nonmycotic hepatic artery pseudoaneurysms after liver transplantation. Liver Transpl Surg1999, 5:200–203.
46.
Manzarbeitia C, Jonsson J, Rustgi V, et al.: Management of hemobilia after liver biopsy in liver transplant recipients. Transplantation 1993, 56:1545–1547.PubMed
47.
Merhav H, Zajko AB, Dodd GD, Pinna A: Percutaneous transhepatic embolization of an intrahepatic pseudoaneurysm following liver biopsy in a liver transplant patient. Transpl Int 1993, 6:239–241.CrossRefPubMed
48.
Baron TH: Hemobilia-induced occlusion of a biliary metal expandable stent. Gastrointest Endosc 2001, 54:362.CrossRefPubMed
49.
Costa MT, Maldonado R, Valente A, et al.: Hemobilia in hereditary hemorrhagic telangiectasia: an unusual complication of endoscopic retrograde cholangiopancreatography. Endoscopy 2003, 35:531–533.CrossRef
50.
Rai R, Rose J, Manas D: Potentially fatal haemobilia due to inappropriate use of an expanding biliary stent. World J Gastroenterol 2003, 9:2377–2378.PubMed
51.
Matthes G, Stengel D, Seifert J, et al.: Blunt liver injuries in polytrauma: results from a cohort study with the regular use of whole-body helical computed tomography. World J Surg 2003, 27:1124–1130.CrossRefPubMed
52.
Croce MA, Fabian TC, Spiers JP, Kudsk KA: Traumatic hepatic artery pseudoaneurysm with hemobilia. Am J Surg 1994, 168:235–238.CrossRefPubMed
53.
Croce MA, Fabian TC, Menke PG, et al.: Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann Surg 1995, 221:744–753.CrossRefPubMed
54.
Goto E, Tateishi R, Shiina S, et al.: Hemorrhagic complications of percutaneous radiofrequency ablation for liver tumors. J Clin Gastroenterol 2009 (Epub ahead of print).
55.
Kim RY, Weintraub JL, Susman J, Haskal ZJ: Radiofrequency ablation for hemobilia secondary to hepatocellular carcinoma. J Vasc Interv Radiol 2002, 13:317–320.CrossRefPubMed
56.
Merrell SW, Gilbertson JJ, Albo D Jr, Mintz SJ: Atraumatic hemobilia arising from a cirrhotic liver. Surgery 1989, 106:105–109.PubMed
57.
Merrell SW, Schneider PD: Hemobilia—evolution of current diagnosis and treatment. West J Med 1991, 155:621–625.PubMed
58.
Bloechle C, Izbicki JR, Rashed MY, et al.: Hemobilia: presentation, diagnosis, and management. Am J Gastroenterol 1994, 89:1537–1540.PubMed
59.
Laffey PA, Teplick SK, Haskin PH: Hemobilia: a cause of false-negative ductal dilatation. J Clin Ultrasound 1986, 14:636–638.CrossRefPubMed
60.
Laffey PA, Brandon JC, Teplick SK, et al.: Ultrasound of hemobilia: a clinical and experimental study. J Clin Ultrasound 1988, 16:167–170.CrossRefPubMed
61.
Enns R, Schmidt N, Harrison P, et al.: Endoscopic diagnosis of a right hepatic artery pseudoaneurysm. Endoscopy 2002, 34:337–340.CrossRefPubMed
62.
Shapiro MJ: The role of the radiologist in the management of gastrointestinal bleeding. Gastroenterol Clin North Am 1994, 23:123–181.PubMed
63.
Tobin MV, Jenkins SA, Gosney JR, Gilmore IT: Use of somatostatin in the management of pancreatic haemobilia. Postgrad Med J 1989, 65:331–332.CrossRefPubMed
64.
Wettstein AR, Meier R: Local application of a potent vasoconstrictor during ERCP for the acute management of hemobilia. Am J Gastroenterol 1998, 93:2644–2645.CrossRefPubMed
65.
Tisi PV, Callam MJ: Surgery versus non-surgical treatment for femoral pseudoaneurysms. Cochrane Database Syst Rev 2006, CD004981.
66.
Ghassemi A, Javit D, Dillon EH: Thrombin injection of a pancreaticoduodenal artery pseudoaneurysm after failed attempts at transcatheter embolization. J Vasc Surg 2006, 43:618–622.CrossRefPubMed
67.
Williams M, Alderson D, Virjee J, Callaway M: CT-guided percutaneous thrombin injection for treatment of an inferior pancreaticoduodenal artery pseudoaneurysm. Cardiovasc Intervent Radiol 2006, 29:669–671.CrossRefPubMed
68.
Dousset B, Sauvanet A, Bardou M, et al.: Selective surgical indications for iatrogenic hemobilia. Surgery 1997, 121:37–41.CrossRefPubMed
69.
• Srivastava DN, Sharma S, Pal S: Transcatheter arterial embolization in the management of hemobilia. Abdom Imaging 2006, 31:439–448. This article is the most recent retrospective review of transcatheter arterial embolization in the management of hemobilia. In this review of 32 patients, TAE was safe and effective in the management of significant hemobilia in the majority of patients.CrossRefPubMed
Metadata
Title
Hemobilia
Authors
Marcus W. Chin
Robert Enns
Publication date
01-04-2010
Publisher
Current Science Inc.
Published in
Current Gastroenterology Reports / Issue 2/2010
Print ISSN: 1522-8037
Electronic ISSN: 1534-312X
DOI
https://doi.org/10.1007/s11894-010-0092-5

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