Hemobilia After Percutaneous Transhepatic Biliary Drainage

Immediate transbiliary embolization of a biliary-hepatic artery fistula encountered during access for percutaneous biliary drainage

“…Among 83 patients, 14 hepatic artery pseudoaneurysms, seven subcapsular hematomas, six arterioportal venous fistulas, and one arteriohepatic venous fistula were noted; however, only one arterioportal venous fistula and four hepatic artery pseudoaneurysms had clinical complications. Other reported vascular injuries after PTBD include varix [4], portobiliary fistula [5], and hepatic artery and portal vein stenosis [6]. To our knowledge, only one direct hepatic artery-biliary fistula related to an hepatic artery pseudoaneurysm after PTBD has been reported [7]; however, there has been no report of a direct hepatic artery-biliary fistula by guidewire perforation during PTBD.…”

Hemobilia

“…The incidence of hemobilia post-PTBD in recent, large series is 2.2% to 2.3% [24, 27•], but older data suggested hemobilia rates as high as 13.8% [28]. In comparison, PTC has a trend toward lower rates (0.7%) [27•].…”

“…The yield of duodenoscopy is dependent on the rate and duration of the bleeding. One case series of patients with severe hemobilia suggested the yield was close to 100% [58], whereas other series with a varying case mix had lower positive endoscopic findings (37.5%) [28]. Although the sensitivity of direct inspection of the papilla may be questioned, clearly it is very specific for the diagnosis of hemobilia.…”

Detection of bile leakage into the thoracic cavity by hepatobiliary scintigraphy

“…[1][2][3][4][5] However, the complication of biliary leakage into the thoracic cavity from an hepatic biliary tree laceration due to spontaneous withdrawal of the catheter for PTCD is very rare. This paper describes simple and early detection of biliary leakage into the right thoracic cavity due to spontaneous withdrawal of the catheter for PTCD by means of nuclear medicine techniques.…”