Hemobilia

Abstract

With advances in computed tomography and magnetic resonance imaging technology, diagnosis with these less invasive investigations are the favored option. However, traditional catheter angiography is still the gold standard. The management of significant hemobilia is still centered on arterial embolization, but arterial and biliary stents have become accepted alternative therapies.

Hemobilia: Perspective and Role of the Advanced Endoscopist

“…As mentioned earlier, intrabiliary clots which form due to hemobilia are often mistaken as gallstones; however, even when gallstones are indeed present, there can still be concurrent hemobilia, especially in cases in which the stone erodes through the cystic artery or other vascular structures and cause bleeding, analogous to how a stone can erode and fistulize into the duodenum and cause outlet obstruction in Bouveret's syndrome [ 29 ]. It is worth mentioning here, although not classified as hemobilia, that hemosuccus pancreaticus (also referred to as Wirsungorrhagia) can occur via pathophysiologically similar mechanisms, for example, pancreatitis eroding into the splenic artery and causing bleeding into the main pancreatic duct [ 30 , 31 ].…”

“…Computed tomography (CT) of the abdomen (preferably angiography protocol) has become a first-choice diagnostic test for hemobilia due to its noninvasive nature, low radiation exposure compared to angiography, rapid results, and diagnostic performance characteristics. CT imaging has improved dramatically over the years such that even subtle salient abnormalities can be identified [ 30 , 34 , 35 ].…”

“…If endoscopic ultrasound (EUS) is available, it may be used as an adjunctive noninvasive method to evaluate vascular aneurysms and blood clots within the biliary ducts when ERCP findings are equivocal [ 36 – 38 ]. EUS can also be used to detect portal biliopathy-related bleeding (e.g., in the context of portal hypertension with intra- or paracholedochal varices [ 30 ].…”

“…Abdominal US has been used to evaluate the presence of blood within the gallbladder, but its diagnostic effectiveness is limited due to its limited ability to visualize the biliary ducts, particular the distal CBD and in patients with truncal obesity. Surgical exploration is usually reserved as a final option in which other modalities are unable to identify or resolve the hemobilia [ 30 ].…”

Diagnosis and Management of Iatrogenic Hemobilia Secondary to Transjugular Intrahepatic Portosystemic Shunt Procedure

“…Hemobilia occurs when a fistulous track forms between a hepatic vessel (hepatic artery or portal vein) and the intrahepatic biliary system or choledocus. The most frequent causes are iatrogenic after hepatobiliary system procedures and trauma [1][2]. The treatment of hemobilia is aimed at stopping the bleeding without interfering with the normal anatomy of the biliary and vascular structures.…”