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.