INTERVENTIONAL TREATMENT OF HEMOBILIA

Purpose: Aim of the study was to assess the use of embolisation in cas es of iatrogenic haemobilia. Method: In 18 patients with severe haemob ilia after percutaneous biliary system drainage or stent implantation, an embolisation with minicoils (17 x) or gelfoam particles [1], was p erformed. To achieve a sufficient vascular obstruction, Histoacryl (4 x) or Ethibloc (1 x) were additionally used in five cases. A transarte rial approach was used in 17 cases. In one patient, an approach throug h the biliary system was possible. Results: In all cases, the bleeding source was identified (5 false aneurysms, three biliary leaks, 9 irre gularities at the junction of the artery and drainage catheter, 1 mult iple collaterals at the proximal end of the stent). In 17 out of 18 ca ses, haemorrhage ceased definitely. In one case of a patient with panc reas carcinoma and obstruction of the portal vein as well as a simulta neous high grade stenosis of the hepatic artery propria, it was only p ossible to embolise small collaterals to avoid liver necrosis. This re sulted in an incomplete bleeding of control. An infected haematoma was the only complication. It was treated by drainage over 10 days. Durin g an observation period ranging approximately 7.6 months, 10 of the pa tients died due to their basic illness. Conclusion: Embolisation is an effective procedure in the treatment of haemobilia, with a low compli cation rate.