Massive Hemobilia Following Traumatic Rupture of the Liver Report of a Case and Review of the Literature*

Traumatic hæmobilia with severe hæmatemesis and melæna: Report of a case and review of the literature

“…Of the 9 cases reported, obvious bleeding into the gut occurred in 5, occult blood was found in I-Sandblom's own patient-and in the other 3 it was not mentioned in the notes; 2 patients died, both from bleeding. Sparkman, in 1953, confining himself to traumatic haemobilia with massive blood-loss, reported I case and found 13 others in the literature. He agreed with the diagnostic criteria, i.e., a non-penetrating abdominal injury followed, after a latent period, by pain suggestive of biliary colic and bleeding into the bowel, but did not accept the importance of the original liver injury being subcapsular.…”

“…Treatment.-Since all the deaths in the recorded cases of traumatic haemobilia have been due to loss of blood, the main aim of treatment must be to stop the bleeding, but according to Sparkman (1953) prophylactic treatment is also important. In his view deep lacerations of the liver should be drained and not completely closed, so as to prevent the formation of a deep cavity.…”

The problems of closed liver injuries

“…A closed cavity may be created within which blood, bile, or pus may accumulate, leading to cyst or abscess formation or the syndrome of traumatic haemobilia. On this account Kreig (1936), Hawthorne, Oaks, and Neese (1941), and Sparkman (1953) suggested that a small drain should be inserted into the depths of a sutured hepatic laceration.…”

“…INCIDENCE The assessment of incidence was found to be difficult, for there were many years in which no cases were seen and information on what percentage of admissions were emergencies was not recorded. However, between 1949 and1953 the incidence in the Cardiff Royal Infirmary was found to be 1 in 4,000, but in one valley (Pontypridd) during the years 1955-57, the incidence was 1 in 1,200. The latter 'Synopsis of a thesis accepted by the University of Cambridge in 1959 for the degree of M.D.…”

A New Diagnostic Aid in Traumatic Hemobilia

“…Mikesky, Howard, and De Bakey reported only one possible case in a review of 300 cases of injuries to the liver (8). Sparkman also reported one case in a series of 100 liver injuries (13). Recently, Trunkey found only one case of hemobilia in a large series of 811 consecutive patients with liver trauma (15).…”