Major hemobilia – experience from a specialist unit in a developing country.
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Date
2011-07
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Abstract
Background and Aim: Hemobilia is a rare but potentially life threatening problem, which can be difficult to diagnose and treat. In the last few decades there has been a change in the
etiologic spectrum and management of this problem in the West. The aim of this study was to
analyze the etiology, clinical features, management and outcome of major hemobilia in a
tertiary referral centre from western India.
Methods: A retrospective analysis was undertaken on 22 patients (16 males, 6 females; mean
age 39 years, range 13 to 74) who presented with major hemobilia over a 5-year period.
Results: The etiology was iatrogenic in 13 patients (percutaneous transhepatic biliary drainage
8, post laparoscopic cholecystectomy 3, endoscopic retrograde cholangiopancreatography
1, and liver biopsy 1), liver trauma in 6 and liver tumors in 3 patients. Twenty patients presented
with gastrointestinal bleeding (melena 20 patients, hemetemesis with melena 8 patients), 5
with jaundice and 8 had fever. Abdominal angiography was performed in 20 patients.
Angiography revealed pseudoaneurysm of the right hepatic artery or its branches in 14
patients, left hepatic artery in 2, an arterio-biliary fistula in 1, tumor blush in 1 and the source
could not be located in 2 patients. Seventeen of the 22 patients were treated with radiological
intervention, 3 required surgery (liver resection for tumors 2, laparotomy for venous collateral
bleeding of portal cavernoma 1) and two were managed conservatively. Radiological
intervention involved embolisation with coils and/or glue in 16, and chemoembolisation in 1
patient. Sixteen of 17 patients responded to embolisation. Overall there were two deaths.
Conclusion: The spectrum of hemobilia seen in India is now similar to that in the developed
world with iatrogenic causes being the commonest. Interventional radiology can treat a majority of patients reducing the need and morbidity associated with surgery.
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Keywords
Hemobilia, interventional radiology
Citation
Gandhi Vidhyachandra, Doctor Nilesh, Marar Shaji, Nagral Aabha, Nagral Sanjay. Major hemobilia – experience from a specialist unit in a developing country. Tropical Gastroenterology. 2011 July-Sept; 32(3): 214-218.