Endoscopic Treatment of Biliary Colic Resulting from Hemobilia after Nonoperative Management of Blunt Hepatic Injury

Clancy, Thomas E.; Warren, Ralph L.

doi:10.1097/00005373-199709000-00025

Cited by 16 publications

(6 citation statements)

References 15 publications

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“…Depending on the amount of blood loss hemobilia may present as a classic upper gastrointestinal bleeding with melaena. In 0.2-3% of blunt hepatic injury hemobilia is present [13]. However, the same happens in case of intraluminal bleeding of the gallbladder wall because of laceration or contusion [14].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…This type of upper gastrointestinal bleeding is often detected not before weeks or even months after the initial injury [14][15][16]. In very rare cases, hemobilia leads to obstruction caused by intrabiliary clots resulting in colic pain and/or jaundice [13,15]. As bile works as a fibrinolytic agent, most intraductal blood clots will be dissolved and will pass the sphincter of Oddi without causing obstructive signs [15].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…On CT intravascular contrast will be extravasal at the site of the lesion. Selective angiography offers the advantage of the possibility to treat active haemorrhage directly by performing embolization [9,13,16,18].…”

Section: Diagnosticsmentioning

confidence: 99%

“…Non-surgical treatment is described in late posttraumatic obstructive cholecystitis in which the symptoms can be relieved by desobstruction of the common bile duct via percutaneous transhepatic cholangiography and drainage [16]. Endoscopic sphincterotomy could be an interesting alternative [13]. However, these techniques are not preferable in presence of coagulopathies.…”

Section: Managementmentioning

confidence: 99%

“…Endoscopic stenting or percutaneous drainage will often be sufficient [13]. On the contrary, extrahepatic bile duct injuries might need surgical exploration in a specialised centre.…”

Section: Managementmentioning

confidence: 99%

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Isolated Gallbladder Injury after Blunt Abdominal Trauma: a Case Report and Review

Tudyka

Toebosch

Zuidema

2007

Eur J Trauma Emerg Surg

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We describe a case of isolated gallbladder contusion after deceleration trauma. On admission, no evident signs of intra-abdominal injury were present. However, after 24 h observation an explorative laparotomy was performed because of persistent abdominal complaints. A contusion of the gallbladder wall was found with intraluminal haematoma and a cholecystectomy was performed. Isolated injury of the gallbladder after blunt trauma is extremely rare. Risk factors are distention of the gallbladder, deceleration trauma and the presence of a relatively mobile gallbladder. Clinical signs often are very subtle. Delayed presentation is common with signs of hemobilia or obstruction due to intraluminal clots. Ultrasound and computed tomography are suitable diagnostic tools. However, the diagnosis is often missed if no other injuries are present. Signs pointing to gallbladder injury are a collapsed gallbladder with pericholecystic fluid or a hydroptic gallbladder with intraluminal hematoma. Hepatobiliary scintigraphy or angiography might be necessary if additional injuries are suspected. The choice of treatment depends on the kind of injury. Contusion of the gallbladder allows conservative treatment, but in case of a rupture, surgery will be necessary. Accompanying bile duct injuries can be treated by endoscopic stenting. If active arterial bleeding is present, selective embolization can be performed.

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Section: Clinical Presentationmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

Section: Diagnosticsmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

“…Endoscopic stenting or percutaneous drainage will often be sufficient [13]. On the contrary, extrahepatic bile duct injuries might need surgical exploration in a specialised centre.…”

Section: Managementmentioning

confidence: 99%

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