Sonographic findings in traumatic hemobilia: Report of two cases and review of the literature

Abstract

Hemobilia consists of an arteriobiliary fistula, usually due to central liver rupture with bleeding into the biliary tree. It is due to trauma in over 50% of cases, with an increasing incidence of iatrogenically caused hemobilia. The sonographic findings in two cases of traumatic hemobilia are presented and the literature is reviewed. These findings include clot within the gallbladder and the extrahepatic ducts, liver hematoma, and aneurysm of the hepatic artery.

Haemobilia

“…One series included ten patients with haemobilia so investigated, of whom eight were reported as having normal bile ducts and the other two as having common bile duct cholelithiasis 175 . The reasons for these ®ndings have been investigated 162,176,177 . Immediately following a bleed into the biliary tract there may be diffuse but high echogenicity similar to that of the liver itself, so that the bile ducts may not be seen at all.…”

Endoscopic Management of Traumatic Hemobilia

“…Ultrasound and computed tomography may contribute to the diagnosis 8,9 as in the present case. Upper gastrointestinal endoscopy detects bleeding from the papilla in approximately 30% of cases.…”

Posttraumatic intra-gallbladder hemorrhage in a patient with liver cirrhosis

“…[16][17][18] US findings in intragallbladder hemorrhage have demonstrated abnormalities ranging from scattered intraluminal echoes to evenly distributed hypoechoic areas throughout the gallbladder to an ovoid hypoechoic mass with smooth borders that moved freely within the gallbladder. 19 Such US findings are not specific for hemobilia and entail differential diagnoses of tumefactive sludge, polyps, tumor, purulent debris, and parasitic remnant. 19,20 However, the clinical setting in our patient made hemobilia the most likely diagnosis.…”

“…19 Such US findings are not specific for hemobilia and entail differential diagnoses of tumefactive sludge, polyps, tumor, purulent debris, and parasitic remnant. 19,20 However, the clinical setting in our patient made hemobilia the most likely diagnosis. CT and US are both noninvasive screening tools, and it is hoped that their use will lead to earlier diagnosis of this rare injury.…”