Hepatic artery angiography and embolization for hemobilia after hepatobiliary surgery

Objective To evaluate the effectiveness of hepatic angiography and emboliza tion in the diagnosis and treatment of hemobilia after hepatobiliary surger y. Methods Nine patients had upper gastrointestinal bleeding 7 days to 3 month s after surgery. They underwent emergency hepatic artery angiography and we re treated by embolization using Gelfoam particles only (8 patients) and Ge lfoam particles plus microsoils (1 patient). Results Hepatic artery angiography revealed hepatic artery pseudoaneurysms in 3 patients, diffuse hemorrhage of the hepatic artery branches in 3, righ t hepatic artery-bile duct fistulas in 2, and hepatic artery-small intestin e fistula in 1. Hemobilia was controlled with embolization in 7 patients, o f whom 1 had recurrent bleeding 1 day after treatment. During the follow-up , 3 patients died of multiple organ dysfunction syndrome. Two patients whos e hemorrhage could not be controlled due to technical reasons died several days later. Conclusion When hemobilia after hepatobiliary surgery is suspected, patient s should receive hepatic angiography as a first diagnostic procedure and be treated with minimally invasive procedure of selective embolization of the involved artery as soon as possible.