HEMOBILIA - PRESENTATION, DIAGNOSIS, AND MANAGEMENT

Objectives: Hemobilia is defined as hemorrhage into the biliary tract. To define a rational approach toward this rare entity, we performed a retrospective study on the presentation, diagnosis, and management of hemobilia. Methods: During the past 3 yr, eight patients suffering fr om severe hemobilia presented to our departments. Jaundice, right-side d upper abdominal pain, and hematemesis were the most frequent symptom s. Hemobilia originated from iatrogenic injury in three patients, mali gnant hepatic or biliary tumors in three, parasitic infestation (ascar iasis) in one, and coagulopathy due to end-stage liver cirrhosis in on e. Duodenoscopy revealed bleeding from the papilla in all patients. Di agnosis was confirmed by endoscopic retrograde cholangiopancreatograph y and angiography in seven patients. Results: In three patients, major liver resections were performed that definitively controlled the blee ding and the underlying tumor. Angiographic occlusion of an arterial l esion was successfully achieved in two patients. In two patients, oper ative ligation of the supplying artery was required, The patient suffe ring from end-stage liver disease was treated by substitution of coagu lation factors but died due to progressive metabolic liver failure. Co nclusion: Angiographic occlusion is recommended as initial treatment t o control hemobilia and to render the patient stable in preparation fo r elective and definitive surgery. Surgery becomes necessary when nono perative attempts to stop the bleeding fail and is required for tumors and parasitic disease.