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Haemobilia

Alternative names
Haemobilia Haemorrhage in bile Hematobilia Hemobilia Hemobilia (disorder) Hemorrhage in bile

Implies bleeding into biliary tree. Can present as acute upper gastrointestinal(UGI) bleeding. It should be considered in upper abdominal pain presenting with UGI bleeding especially when there is a history of liver injury or instrumentation.

First recorded in 1654 by Francis Glisson, a Cambridge professor^[1].
Haemobilia occurs when there is a fistula between a vessel of the splanchnic circulation and the intrahepatic or extrahepatic biliary system.

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Causes

Trauma, accidental or iatrogenic e.g. due to procedures like cholecystectomy
Instrumentation e.g. after ERCP
Gallstone
Inflammatory conditions ranging from ascariasis to PAN
Vascular malformation
Tumor
Coagulopathy

Clinical feature

Triad of upper abdominal pain, upper gastrointestinal haemorrhage and jaundice^[2] is classical but only present in 22% cases^[3].
It can be immediately life threatening in major bleeding. However in minor haemobilia patient is haemodynamically stable despite significant blood loss being apparent ^[3].

Investigation

Combination of OGD, CT scan and angiography depending on clinical situation, bearing in mind that haemobilia may present many days after injury. Cholengiography is performed if there is a percutaneous access or if ERCP is undertaken.

Management

Most bleeding from instrumentation are minor and would settle spontaneously.
When indicated, management is directed towards stopping bleeding and relieving obstruction if present, which is achieved either by surgical ligation of hepatic artery or by endoscopic embolisation. Endoscopic trans-arterial embolisation (TAE) is preferred initially because of high success rate and less complication. TAE involves the selective catheterization of a hepatic artery followed by embolic occlusion. Surgery is indicated when TAE has failed or sepsis present in biliary tree or drainage has failed.

References

^ Francis Glisson,. From Anatomia hepatis (the Anatomy of the liver), 1654 (Cambridge Wellcome texts and documents). Cambridge: Wellcome Unit for the History of Medicine. ISBN 0-9516693-3-8. OCLC 33046433.
^ Quincke, H. (1871). "Ein Fall von Aneurysma der Leberarterie". Berl Klin Wochenschr 30: 349--352.
^ ^a ^b Green M, Duell R, Johnson C, Jamieson N (2001). "Haemobilia". The British journal of surgery 88 (6): 773-86. PMID 11412246.

Categories: Gastroenterology | Hepatology

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Haemobilia". A list of authors is available in Wikipedia.

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