Formation and Fate of Fibrin Clots in the Biliary Tract

Abstract

Fibrin clots may form in the biliary tract from hemobilia or in inflammatory disease. There is a wide variation in the clinical course of such clots which is exemplified by 9 patients. They may either dissolve through fibrinolysis, get ejected into the intestine, remain and obstruct the biliary tract, or may even transform into gallstones. In order to elucidate the mechanisms involved, the behavior of blood clots in bile was studied in vitro. A model was constructed of the biliary tract and, drained by a T-tube, where human bile circulated with a flow rate resembling that in vivo. When a small amount of human blood was injected, it flowed immiscibly to the lowest level, displaced the bile, and formed a clot of pure blood. Even a minor bleeding may thus form a coagulum. This is different from the mixed clot of blood and bile that forms in experiments simulating major hemorrhage. These findings are related to clinical experience and especially to the disappearance of "retained stones" with or without the use of dissolving agents.

Acute Cholecystitis Secondary to Hemobilia after Percutaneous Liver Biopsy

“…The number of passes varied from 1 to 3 in the 4 cases reported in the literature [6, 7, 8, 9]. In the present case, it was performed in 2 passes.…”

“…Only few cases of acute cholecystitis secondary to percutaneous liver biopsy have been reported [6, 7, 8, 9, 10, 11]. The number of passes varied from 1 to 3 in the 4 cases reported in the literature [6, 7, 8, 9].…”

“…However, blood is not miscible in bile and may clot in the absence of bile flow. Sandblom et al [9]demonstrated in vitro that clot dissolution occurs only in presence of bile flow. When a blood clot forms in the gallbladder, dissolution may not ensue.…”

“…These complications include bleeding into the peritoneal or thoracic cavity, hemobilia, enteric perforation, and intrahepatic hematoma [3, 4, 5]. Only few cases of acute cholecystitis have been described after liver biopsy [6, 7, 8, 9, 10, 11]. Our objective is to report the case of a patient who developed acute cholecystitis secondary to percutaneous liver biopsy.…”

Hemobilia following T-Tube Drainage of the Common Duct

“…Diagnosis can be obvious when a T-tubc has been inserted into the common duct but usually gastrointestinal endoscopy and selective angiog raphy of the hepatic artery are necessary to establish the diagnosis [5]. In an experimental model, it was shown that minor hemobilia produces pure blood clots, whereas in major hemorrhage, mixed clots of blood and bile are formed [6]. Blood clots are often casts of the biliary tree and when they are small and distal in the common duct they appear as filling defects on the T-tube cholangio gram which can be mistaken for retained stones [7], With minor hemobilia treatment can be conservative [8]; when the hemorrhage is profuse or persistent, surgery must be undertaken although in selected cases angio graphic embolization can be performed [9][10][11].…”