Hepatic hemobilia: Hemorrhage from the intrahepatic biliary tract, a review

Abstract

Hepatic hemobilia is defined as hemorrhage arising from pathological changes in the intrahepatic biliary tract. The main causes are iatrogenic trauma, cholangitis, tumors, and coagulopathy. The salient features of the hemobilia syndrome are described and their causes explained. The treatment, when necessitated by hemorrhage or clot formation, is either resection of the liver or occlusion of the responsible artery by ligature or embolization. The iatrogenic trauma may be operative, resulting from instrumental lesion of the bile ducts, needle biopsy, transhepatic cholangiography, biliary tract prosthesis, or inlaying hepatic artery catheters. Among the inflammatory etiologies, special attention is given to nematodes in the ducts, "the tropical hemobilia." Spontaneous hemobilia may, just as nose bleeds or hematuria, result from treatment with anticoagulants.

Traumatic Bile Duct Injuries

“…The majority of symptomatic hemobilias are caused by arterial bleed while hemobilias from venous injuries are quite rare [38]. The frequency of hemobilia after trauma ranges between 3 and 7% [39] with the majority of patients experiencing clinically insignificant and self-limiting blood loss into the biliary tree and in the upper gastrointestinal tract [39]. In these circumstances, arterial blood seeps into the biliary tree and, due to the fibrinolytic activity of the bile, clots rapidly dissolve and often go unnoticed [39].…”

“…The frequency of hemobilia after trauma ranges between 3 and 7% [39] with the majority of patients experiencing clinically insignificant and self-limiting blood loss into the biliary tree and in the upper gastrointestinal tract [39]. In these circumstances, arterial blood seeps into the biliary tree and, due to the fibrinolytic activity of the bile, clots rapidly dissolve and often go unnoticed [39]. In a very small proportion of patients, clots might not dissolve and form biliary plugs that can cause biliary obstruction causing jaundice and colic pain [38,39].…”

“…In these circumstances, arterial blood seeps into the biliary tree and, due to the fibrinolytic activity of the bile, clots rapidly dissolve and often go unnoticed [39]. In a very small proportion of patients, clots might not dissolve and form biliary plugs that can cause biliary obstruction causing jaundice and colic pain [38,39]. The majority of symptomatic patients with hemobilia present with melena (90%), abdominal pain (70%), and obstructive jaundice (60%) [40,41].…”

Clinical study of surgical jaundice: an institutional experience

“…1 Other, less common causes of bile duct obstruction include choledochal cysts, indwelling biliary cathers, blood clots in the bile duct because of hemobilia, strictures that develop with Caroli's diseases and extrinsic compression of the bile duct. [2][3][4] In all cases of surgical jaundice, it is mandatory to determine preoperatively the exact nature and the site of obstruction because an ill-chosen therapeutic approach can be dangerous. 5 Patients with obstruction of the bile duct may develop nutritional deficits, impairment of cardiovascular and renal function, and have infectious complications that have an impact on their outcomes.…”

Life-threatening hemobilia caused by hepatic artery pseudoaneurysm: A rare complication of chronic cholangitis

“…Impacted stones may also erode the biliary mucosa and lead to bleeding. Severe hemobilia is rare, but can occur when a large stone erodes vessels of the hepatoduodenal ligament or the cystic artery [6] . In contrast, hemobilia caused by reflux cholangitis without stones or parasitic infection, has not yet been reported and its mechanism is unclear.…”