Hepatic Haemobilia: Non‐operative Management in Eight Cases

Abstract

Eight cases of major haemobilia have been seen by the Surgical Hepatobiliary service at Westmead Hospital between 1979 and 1984. Two occurred following blunt abdominal trauma, three after percutaneous biliary drainage or liver biopsy, two in association with postoperative haemorrhagic pancreatitis and one because of an abscess complicating hepatic hydatid disease. Coeliac and superior mesenteric angiography were carried out in all patients, and false aneurysms were demonstrated in seven of the eight. A marked coagulopathy was present in the remaining patient, in whom bleeding stopped without intervention when the coagulopathy was reversed. Those with false aneurysms were treated by radiologically controlled transarterial embolization with gelfoam, acrylate or Gianturco coils, and bleeding was controlled in all. There was one death from overwhelming sepsis in the patient with the hepatic abscess. It is concluded that percutaneous radiologically controlled embolization is the treatment of choice for most cases of haemobilia, except when there is major hepatic sepsis.

Gastrointestinal Bleeding Secondary to Hepatic Artery Involvement of Microscopic Polyangiitis: Case Report and Review of the Literature

“…In a group of 171 patients with hemobilia, 73 [43%] required only conservative treatment [21]. In the case of continued bleeding, TAE as in our case has been shown to be successful in 80-100% of cases [27][28][29][30]. Since the reported morbidity and mortality rates of TAE are lower than for surgery, TAE should be attempted first.…”

Management of massive haemobilia in an Indian hospital

“…The success rate of TAE as reported in most series is 80-100 percent [2][3][4][5][6][7]9]. Most of them however have evaluated both massive and minor haemobilia together.…”

“…Due to its rarity and diffi cult diagnosis an optimal management protocol remains unclear. Since its introduction in 1976, the trans-arterial embolisation (TAE) has gained repute as a fi rst line intervention to stop bleeding [2][3][4][5][6][7][8][9]. Other interventional approaches like endoscopic sclerotherapy [10], embolisation of the needle liver biopsy tract [11] have also been reported as case snippets.…”

Potentially fatal haemobilia due to inappropriate use of an expanding biliary stent

“…In a recent review of 171 cases of haemobilia, 73 (43 %) patients required only conservative treatment [1] . In case of continued bleeding, transarterial embolisation has been shown to be successful in 80 % to 100 % of cases [10][11][12][13][14] . Since the reported morbidity and mortality rates of transhepatic arterial embolisation (TAE) were lower than surgery [14] , angiographic embolisation should be attempted first.…”

“…In case of continued bleeding, transarterial embolisation has been shown to be successful in 80 % to 100 % of cases [10][11][12][13][14] . Since the reported morbidity and mortality rates of transhepatic arterial embolisation (TAE) were lower than surgery [14] , angiographic embolisation should be attempted first. The relative contraindication of arterial embolisation is hepatic sepsis, and in case of portal vein obstruction, arterial embolisation can cause hepatic necrosis.…”