| Haemobilia | |
|---|---|
| Other names | Haemorrhage in bile, Haematobilia, Hematobilia, Hemobilia, Hemobilia (disorder) |
| Specialty | Gastroenterology  |
Haemobilia is a medical condition of bleeding into thebiliary tree. Haemobilia occurs when there is afistula between a vessel of thesplanchnic circulation and theintrahepatic orextrahepatic biliary system. It can present as acute upper gastrointestinal (UGI) bleeding. It should be considered in upper abdominal pain presenting with UGI bleeding especially when there is a history of liver injury or instrumentation.[citation needed]
Haemobilia was first recorded in 1654 by Francis Glisson, aCambridge professor.[1]
Quincke's triad of upper abdominal pain,upper gastrointestinal haemorrhage andjaundice[2] is classical but only present in 22% cases.[3]
It can be immediately life-threatening in major bleeding. However, in minor haemobilia, patient is haemodynamically stable despite significant blood loss being apparent.[3]
The causes of haemobilia includetrauma (which can be accidental oriatrogenic due to procedures such ascholecystectomy), instrumentation (especially afterERCP),gallstone,inflammatory conditions ranging fromascariasis toPAN, vascularmalformation,tumors,coagulopathy, andliver biopsy.[4]
Combination ofEGD,CT scan andangiography depending on clinical situation, bearing in mind that haemobilia may present many days after injury.Cholangiography is performed if there is a percutaneous access or ifERCP is undertaken.[citation needed]
Most bleeding from instrumentation are minor and would settle spontaneously.[citation needed]
When indicated, management is directed towards stopping bleeding and relieving obstruction if present, which is achieved either bysurgical ligation of hepatic artery or byendovascularembolisation. Endovasculartrans-arterial embolisation (TAE) is preferred initially because of high success rate and less complication. TAE involves the selective catheterization of a hepatic artery followed by embolic occlusion. Surgery is indicated when TAE has failed or sepsis present in biliary tree or drainage has failed.[citation needed]