Transcatheter arterial embolization in the management of hemobilia

Abstract

TAE is a safe and effective interventional radiologic procedure in the nonoperative management of patients who have significant hemobilia.

Traumatic Bile Duct Injuries

“…The majority of symptomatic patients with hemobilia present with melena (90%), abdominal pain (70%), and obstructive jaundice (60%) [40,41]. In trauma, hemobilia should always be suspected when patients present with upper gastrointestinal bleeding since this condition can occur as a late complication [38]. Diagnosis of hemobilia can be confirmed by arterial phase computerized tomography (CT) or selective hepatic artery arteriography.…”

“…The majority of symptomatic hemobilias are caused by arterial bleed while hemobilias from venous injuries are quite rare [38]. The frequency of hemobilia after trauma ranges between 3 and 7% [39] with the majority of patients experiencing clinically insignificant and self-limiting blood loss into the biliary tree and in the upper gastrointestinal tract [39].…”

“…In these circumstances, arterial blood seeps into the biliary tree and, due to the fibrinolytic activity of the bile, clots rapidly dissolve and often go unnoticed [39]. In a very small proportion of patients, clots might not dissolve and form biliary plugs that can cause biliary obstruction causing jaundice and colic pain [38,39]. The majority of symptomatic patients with hemobilia present with melena (90%), abdominal pain (70%), and obstructive jaundice (60%) [40,41].…”

“…Diagnosis of hemobilia can be confirmed by arterial phase computerized tomography (CT) or selective hepatic artery arteriography. Selective arteriogram by percutaneous approach has become the leading modality to treat hemobilia with microembolization of the arterial branches communicating with the biliary tree with success rates in 84-95% of patients [38,42]. In the last decade, diagnosis of hemobilia by upper endoscopy has become less frequent as the majority of patients, particularly those with blunt traumas, undergo CT scans that are very sensitive and specific in identifying evidence of active or recent bleeding into the biliary tree and gallbladder by pooling of contrast in the biliary system and presence of intraluminal clots or biliary dilatation [43,44].…”

Hemobilia – a rare cause of gastrointestinal bleeding successfully treated using associated endovascular and endoscopic procedures

“…Bardzo dobre wyniki stwierdzono w krwawieniach pourazowych (najczęściej tępe urazy wątroby), powikłaniach jatrogennych, krwawiących guzach wątroby, anomaliach naczyniowych i tętniakach tętnic wątrobowych. Liczne doniesienia dowodzą wysokiej skuteczności i bezpieczeństwa tej metody terapii [3][4][5][6][7][8]. Pacjenci, u których endowaskularna embolizacja nie spowodowała zatrzymania krwawienia, muszą być leczeni operacyjnie.…”