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Hepatic hemobilia of traumatic or iatrogenic origin: Recent advances in diagnosis and therapy, review of the literature from 1976 to 1981

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Abstract

A rare lesion, macroscopic hemobilia involving the liver, is usually of traumatic or iatrogenic origin. A review of the international literature published between 1976 and 1981 demonstrated 73 such cases, including 50 of an iatrogenic nature. Among the diagnostic investigations employed, duodenal fibroscopy gave negative results in 50% of cases. Ultrasonography and computed tomography are now replacing scintigraphy with99mtechnetium as a diagnostic procedure for intrahepatic fluid collections. The most reliable method is arteriography, this alone providing both diagnostic and topographic data. The fact that treatment by endovascular route was successful in 24 of the 28 patients suggests that the need for surgery requires reconsideration, particularly in cases of iatrogenic origin.

Résumé

L'hémobilie, syndrome rare, est généralement d'origine traumatique ou iatrogène. Une revue de la littérature internationale publiée entre 1976 et 1981 a permis d'en colliger 73 cas dont 50 d'origine iatrogène. Parmi les moyens d'exploration employés la duodénoscopie se solde par 50 pour cent de résultats négatifs. L'ultrasonographie et la tomodensitométrie remplacent avantageusement la scintigraphie biliaire (99m-Technecium) pour dépister la présence de collections intra-hépatiques. Le procédé le plus fiable d'exploration est l'artériographie. Elle permet de porter le diagnostic et de déterminer le siège de la collection.

Le fait que le traitement par embolisation ait été suivi de succès dans 24 cas d'hémobilie sur 28 suggère la remise en cause du traitement chirurgical en particulier lorsque l'hémobilie est d'origine iatrogène.

Resumen

La hemobilia que involucra al hígado, una lesión muy rara, usualmente es de origen traumático o iatrogénico. La revisión de la literatura internacional entre 1976 y 1981 demostró 73 de tales casos, incluyendo 50 de naturaleza iatrogénica. Entre los diferentes métodos de investigación diagnóstica empleados, la fibroscopia duodenal dió resultados negativos en el cincuenta por ciento de los casos; la ultrasonografía y la tomografía computadorizada proveen información más precisa sobre los límites y localizatión del hematoma en el hígado, y por consiguiente están reemplazando a la scintigrafía con 99m-tecnecio como procedimientos diagnósticos en casos de colecciones líquidas intrahepáticas. El método más confiable es la arteriografía, procedimiento que puede definir y localizar la lesión arterial en el lugar de origen de la hemobilia, lo cual de por sí representa información tanto diagnóstica como topográfica.

En la mayoría de los casos la serveridad y la repetitión de la hemobilia requiere intervención para hemostasis. Tres procedimientos terapéuticos son aplicables: hepatectomía, ligadura arterial y hemostasis por la vía endovascular. La vía endovascular incluye embolización, disección arterial e infusión intra-arterial superselectiva de drogas vasoactivas; la embolización ha sido ultizada en 25 de 28 casos de hemobilia de origen traumático o iatrogénico, y puesto que es una forma efectiva de terapia, debe ser contemplada en aquellos casos en que no exista indicación formal para laparotomía o drenaje de un foco séptico. El hecho de que el tratamiento por la vía endovascular fué exitoso como procedimiento terapéutico en 24 de 28 pacientes, hace que la indicación de cirugía sea reconsiderada, especialmente en casos de origen iatrogénico.

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Curet, P., Baumer, R., Roche, A. et al. Hepatic hemobilia of traumatic or iatrogenic origin: Recent advances in diagnosis and therapy, review of the literature from 1976 to 1981. World J. Surg. 8, 2–8 (1984). https://doi.org/10.1007/BF01658356

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