Abstract
Ten patients with massive hemobilia in shock or preshock status were treated with angiography. The hemobilia had been induced by iatrogenic trauma: biliary drainage in seven patients, and surgery, liver biopsy, and angiography in one patient each. Angiography was performed on all patients. Embolization was performed in nine, and in the one remaining patient, spasm of the right anterior hepatic artery and catheter manipulation injured the intima and obliterated the artery. In seven patients with hepatic artery pseudoaneurysm, gelfoam particles were injected in five, however, extravasation could not be prevented in four of these patients. Permanent embolic materials were added and complete hemostatis was obtained. Hemobilia never recurred in any patient. Emergency embolization should be considered as the initial treatment of choice for hemobilia and when pseudoaneurysms are discovered, they should be obliterated by permanent embolic materials. Moreover, tumor thrombus in the portal vein is not a contraindication for this procedure.
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Sandblom P. Hemobilia (biliary tract hemorrhage). History, pathology, diagnosis, treatment. Springfield, Illinois: Charles C. Thomas, 1972:5
Czerniak A, Thompson JN, Hemingway AP, Soreide O, Benjamin IS, Allison DJ, Blumgart LH. Hemobilia. A disease in evolution.Arch Surg 1988; 123:718–721
Heimbach DM, Ferguson GS, Harley JD. Treatment of traumatic hemobilia with angiographic embolization.J Trauma 1978; 18:221–224
Stanley JC, Thompson NW, Fry WJ. Splanchnic artery aneurysms.Arch Surg 1970; 101:689–697
Busuttil RW, Brin BJ. The diagnosis and management of visceral artery aneurysms.Surgery 1980; 88:619–624
Lewis FR, Lim RC, Blaisdell FW. Hepatic artery ligation. Adjunct in the management of massive hemorrhage from the liver.J Trauma 1974; 14:743–755
Poulos E, Wilkinson LH, Simms AG, Floyd VT. Traumatic hemobilia treated by massive liver resection.Arch Surg 1964; 88:596–601
Goldblatt M, Goldin AR, Shaff MI. Percutaneous embolization for the management of hepatic aneurysms.Gastroenterology 1977; 73:1142–1146
Uflacker R. Transcatheter embolisation of arterial aneurysms.Br J Radiol 1986; 59:317–324
Sandblom P. Hemorrhage into the biliary tract following trauma. Traumatic hemobilia.Surgery 1948; 24:571–586
Walter JF, Paaso BT, Cannon WB. Successful transcatheter embolic control of massive hematobilia secondary to liver biopsy.AJR 1976; 127:847–849
Tegtmeyer CJ, Bezirdjian DR, Ferguson WW, Hess CE. Transcatheter embolic control of iatrogenic hematobilia.Cardiovasc Intervent Radiol 1981; 4:88–92
Uflacker R, Mourao GS, Piske RL, Souza VC, Lima S. Hemobilia. Transcatheter occlusive therapy and long-term follow-up.Cardiovasc Intervent Radiol 1989; 12:136–141
Hoevels J, Nilsson U. Intrahepatic vascular lesions following nonsurgical percutaneous transhepatic bile duct intubation.Gastrointest Radiol 1980; 5:127–135
Kadir S, Athanasoulis CA, Ring EJ, Greenfield A. Transcatheter embolization of intrahepatic arterial aneurysms.Radiology 1980; 134:335–339
Mitchell SE, Shuman LS, Kaufman SL, Chang R, Kadir S, Kinnison ML, White RI. Biliary catheter drainage complicated by hemobilia. Treatment by balloon embolotherapy.Radiology 1985; 157:645–652
Sarr MG, Kaufman SL, Zuidema GD, Gameron JL. Management of hemobilia associated with transhepatic internal biliary drainage catheters.Surgery 1984; 95:603–607
Monden M, Okamura J, Kobayashi N, Shibata N, Horikawa S, Fujimoto T, Kosaki G, Kuroda C, Uchida H. Hemobilia after percutaneous transhepatic biliary drainage.Arch Surg 1980; 115:161–164
Curet P, Baumer R, Roche A, Grellet J, Mercadier M. Hepatic hemobilia of traumatic or iatrogenic origin: recent advances in diagnosis and therapy, review of the literature from 1976–1981.World J Surg 1984; 8:2–8
Bismuth H. Hemobilia.N Engl J Med 1973; 288:617–619
Casula G, Scattone S, Cossu L, Simonetti G. Hemobilia from ruptured hepatic artery aneurysm. Angiographic demonstration of arteriobiliary fistula in a successfully treated case.Gastrointest Radiol 1984; 9:171–173
Harlaftis NN, Akin JT. Hemobilia from ruptured hepatic artery aneurysm. Report of a case and review of the literature.Am J Surg 1977; 133:229–232
Yamada R, Sato M, Kawabata M, Nakatsuka H, Nakamura K, Takashima S. Hepatic artery embolization in 120 patients with unresectable hepatoma.Radiology 1983; 148:397–401
Trojanowski JQ, Harrist TJ, Athanasoulis CA, Greenfield AJ. Hepatic and splenic infarctions. Complications of therapeutic transcatheter embolization.Am J Surg 1980; 139:272–277
Fujimitsu R, Okazaki M, Koganemaru F, Fujitomi Y, Kameda S. A long surviving hepatocellular carcinoma case (5 years 3 months) with tumor thrombus in the portal trunk treated by embolization.Act Hepatol Jpn 1990; 31:439–443
Takayasu K, Moriyama N, Muramatsu Y, Suzuki M, Yamada T, Kishi K, Hasegawa H, Okazaki N. Hepatic arterial embolization for hepatocellular carcinoma.Radiology 1984; 150:661–665
Lina JR, Jaques P, Mandell V. Aneurysm rupture secondary to transcatheter embolization.AJR 1979; 132:553–556
Okazaki M, Higashihara H, Koganemura F, Ono H, Hoashi T, Kimura T. A coaxial catheter and steerable guidewire used to embolize branches of the splanchnic arteries.AJR 1990; 155:405–406
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Okazaki, M., Ono, H., Higashihara, H. et al. Angiographic management of massive hemobilia due to iatrogenic trauma. Gastrointest Radiol 16, 205–211 (1991). https://doi.org/10.1007/BF01887347
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DOI: https://doi.org/10.1007/BF01887347