Hemobilia: Etiology, diagnosis, and treatment

Abstract

Hemobilia refers to bleeding from and/or into the biliary tract and is an uncommon but important cause of gastrointestinal hemorrhage. Reports of hemobilia date back to the 1600s, but due to its relative rarity and challenges in diagnosis, only in recent decades has hemobilia been more critically studied. The majority of cases of hemobilia are iatrogenic and caused by invasive procedures involving the liver, pancreas, bile ducts and/or the hepatopancreatobiliary vasculature, with trauma and malignancy representing the two other leading causes. A classic triad of right upper quadrant pain, jaundice, and overt upper gastrointestinal bleeding has been described (i.e. Quincke’s triad), but this is present in only 25%–30% of patients with hemobilia. Therefore, prompt diagnosis depends critically on having a high index of suspicion, which may be based on a patient’s clinical presentation and having recently undergone (peri-) biliary instrumentation or other predisposing factors. The treatment of hemobilia depends on its severity and suspected source and ranges from supportive care to advanced endoscopic, interventional radiologic, or surgical intervention. Here we provide a clinical overview and update regarding the etiology, diagnosis, and treatment of hemobilia geared for specialists and subspecialists alike.

Mycotic pseudoaneurysm of the hepatic artery as a complication of radiofrequency ablation of hepatic metastases

“…Hepatic RFA is associated with a complication rate of 3.1% [13] . Vascular complications (such as hemobilia [14] and pseudoaneurysms [15] ) occur between 0.5% and 1% [16] . Tumor seeding and abscess formation occurs in 0.3%-2% of cases [15] , [16] , [17] , [18] .…”

Hemobilia after bile duct resection: perforation of pseudoaneurysm into intra-pancreatic remnant bile duct: a case report

“…Second, Endoscopic balloon tamponade was used as temporary hemostasis and subsequent radiological interventional approach. The treatment of hemobilia is achieved by a hemostasis and consequently preventing obstructive jaundice [ 4 ]. Hemodynamic parameters were stable with no clear source of bleeding on initial images.…”

A pseudoaneurysm of the right hepatic artery treated successfully with a stent graft – A case report

“…Quincke's triad of symptoms in haemobilia consists of upper gastro-intestinal hemorrhage, jaundice and upper abdominal pain. However, the classic triad of symptoms is only present in 20–40% of the patients [ 2 , 3 ]. Described treatment methods of pseudoaneurysms causing haemobilia are embolization, implanting stent grafts, thrombin injections and surgery [ 2 , [4] , [5] , [6] ].…”