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Difficult Decisions in Hepatobiliary and Pancreatic Surgery pp 341–348Cite as

Management of Significant Hemobilia: Hepatic Artery Embolization or Stenting?

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Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

Abstract

Hemobilia is a rare but potentially life-threatening cause of upper gastrointestinal bleed. Most common causes include iatrogenic injury and trauma with pseudoaneurysm the most common anomaly identified. Therapeutic options include surgery, arterial embolization, or biliary stenting. Based on the etiology of hemobilia, endoscopic or percutaneous biliary covered stenting can be considered to tamponade the source of hemorrhage. However, in the majority of cases, angiography is required to identify and, ultimately, treat the source of bleeding with arterial embolization. Both arterial embolization and biliary stenting are effective, relatively safe, and cost efficient approaches to treatment of hemobilia which can be used based on the etiology of hemorrhage.

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References

  1. Glisson F. Anatomia hepatis. London: O. Pullein; 1654.

    Google Scholar 

  2. Green MH, Duell RM, Johnson CD, Jamieson NV. Haemobilia. Br J Surg. 2001;88:773–86.

    Article  CAS  PubMed  Google Scholar 

  3. Blumenthal DS. Ascariasis. Cecil textbook of medicine. 18th ed. Philadelphia: WB Saunders; 1988.

    Google Scholar 

  4. Koshy A, Khuroo MS, Suri S, Datta DV, Khanna SK. Amoebic liver abscess with hemobilia. Am J Surg. 1979;138:453–5.

    Article  CAS  PubMed  Google Scholar 

  5. Adam R, Fabiani B, Bismuth H. Hematobilia resulting from heterotopic stomach in the gallbladder neck. Surgery. 1989;105:564–9.

    CAS  PubMed  Google Scholar 

  6. Yoshida J, Donahue PE, Nyhus LM. Hemobilia: review of recent experience with a worldwide problem. Am J Gastroenterol. 1987;82:448–53.

    CAS  PubMed  Google Scholar 

  7. Pongchairerks P. Ultrasound-guided liver biopsy: accuracy, safety and sonographic findings. J Med Assoc Thai. 1993;76:597–600.

    CAS  PubMed  Google Scholar 

  8. Piccinino F, Sagnelli E, Pasquale G, Giusti G. Complications following percutaneous liver biopsy. A multicenter retrospective study on 68276 biopsies. J Hepatol. 1986;2:165–73.

    Article  CAS  PubMed  Google Scholar 

  9. Monden M, Okamura J, Kobayashi N, et al. Hemobilia after percutaneous transhepatic biliary drainage. Arch Surg. 1980;115:161–4.

    Article  CAS  PubMed  Google Scholar 

  10. Fidelman N, Bloom AI, Kerlan RK, et al. Hepatic arterial injuries after percutaneous biliary interventions in the era of laparoscopic surgery and liver transplantation: experience with 930 patients. Radiology. 2008;247:880–6.

    Article  PubMed  Google Scholar 

  11. Rivera-Sanfeliz GM, Assar OS, Laberge JM, et al. Incidence of important hemobilia following transhepatic biliary drainage: left-sided versus right-sided approaches. Cardiovasc Intervent Radiol. 2004;27:137–9.

    Article  CAS  PubMed  Google Scholar 

  12. Muhldorfer SM, Kekos G, Hahn EG, et al. Complications of therapeutic gastrointestinal endoscopy. Endoscopy. 1992;24:276–83.

    Article  CAS  PubMed  Google Scholar 

  13. Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol. 2001;96:417–23.

    Article  CAS  PubMed  Google Scholar 

  14. Ferreira L, Baron TH. Post-sphincterotomy bleeding: who, what, when, and how. Am J Gastroenterol. 2007;102:2850–8.

    Article  PubMed  Google Scholar 

  15. Wilcox CM, Canakis J, Monkemuller KE, et al. Patterns of bleeding after endoscopic sphincterotomy, the subsequent risk of bleeding, and the role of epinephrine injection. Am J Gastroenterol. 2004;99:244–8.

    Article  PubMed  Google Scholar 

  16. Quinke H. Ein fall von aneurysma der leberarterie. Klin Wochenschr. 1871;8:349–51.

    Google Scholar 

  17. Chin MW, Enns R. Hemobilia. Curr Gastroenterol Rep. 2010;12:121–9.

    Article  PubMed  Google Scholar 

  18. Nicholson T, Travis S, Ettles D, et al. Hepatic artery angiography and embolization for hemobilia following laparoscopic cholecystectomy. Cardiovasc Intervent Radiol. 1999;22:20–4.

    Article  CAS  PubMed  Google Scholar 

  19. Marynissen T, Maleux G, Heye S, et al. Trancatheter arterial embolization for iatrogenic hemobilia is a safe and effective procedure: case series and review of the literature. Eur J Gastroenterol Hepatol. 2012;24:905–9.

    Article  PubMed  Google Scholar 

  20. Moodley J, Singh B, Lalloo S, et al. Non-operative management of haemobilia. Br J Surg. 2001;88:1073–6.

    Article  CAS  PubMed  Google Scholar 

  21. Srivastava DN, Sharma S, Pal S, et al. Transcatheter arterial embolization in the management of hemobilia. Abom Imaging. 2006;31:439–48.

    Article  Google Scholar 

  22. Murugesan SD, Sathyanesan J, Lakshmanan A, et al. Massive hemobilia: a diagnostic and therapeutic challenge. World J Surg. 2014;38:1755–62.

    Article  PubMed  Google Scholar 

  23. Cao H, Liu J, Li T, et al. Interventional therapy for the treatment of severe hemobilia after percutaneous transhepatic cholangial drainage: a case series. Int Surg. 2013;98:223–8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Itoi T, Yasuda I, Doi S, et al. Endoscopic hemostasis using covered metallic stent placement for uncontrolled post-endoscopic sphincterotomy bleeding. Endoscopy. 2011;43:369–72.

    Article  CAS  PubMed  Google Scholar 

  25. Valats JC, Funakoshi N, Bauret P, et al. Covered self-expandable biliary stents for the treatment of bleeding after ERCP. Gastrointest Endosc. 2013;78(1):183–7.

    Article  PubMed  Google Scholar 

  26. Shah JN, Marson F, Binmoeller KF. Temporary self-expandable metal stent placement for treatment of post-sphincterotomy bleeding. Gastrointest Endosc. 2012;72(6):1274–8.

    Article  Google Scholar 

  27. Aslinia F, Hawkins L, Darwin P, et al. Temporary placement of a fully covered metal stent to tamponade bleeding from endoscopic papillary balloon dilation. Gastrointest Endosc. 2012;76(4):911–3.

    Article  PubMed  Google Scholar 

  28. Kawaguchi Y, Ogawa M, Maruno A, et al. A case of successful placement of a fully covered metallic stent for hemobilia secondary to hepatocellular carcinoma with bile duct invasion. Case Rep Oncol. 2012;5:682–6.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Layec S, D’Halluin PN, Pagenault M, et al. Massive hemobilia during extraction of a covered self-expandable metal stent in a patient with portal hypertensive biliopathy. Gastrointest Endosc. 2009;70(3):555–6.

    Article  PubMed  Google Scholar 

  30. Song JY, Moon JH, Choi HJ, et al. Massive hemobilia following transpapillary bile duct biopsy treated by using a covered self-expandable metal stent. Endoscopy. 2014;46:E161–2.

    Article  PubMed  Google Scholar 

  31. Bagla P, Erim T, Berzin TM, et al. Massive hemobilia during endoscopic retrograde cholangiopancreatography in a patient with cholangiocarcinoma: a case report. Endoscopy. 2012;44:E1.

    Article  PubMed  Google Scholar 

  32. Goenka MK, Harwani Y, Rai V. Fully covered self-expandable metal biliary stent for hemobilia caused by portal biliopathy. Gastrointest Endosc. 2014;80:1175.

    Article  PubMed  Google Scholar 

  33. Rerknimitr R, Kongkam P, Kullavanijaya P. Treatment of tumor associated hemobilia with a partially covered metallic stent. Endoscopy. 2007;39:E225.

    Article  PubMed  Google Scholar 

  34. Lorenz JM, Zangan SM, Leef JA, et al. Iatrogenic portobiliary fistula treated by stent-graft placement. Cardiovasc Intervent Radiol. 2010;33:421–4.

    Article  PubMed  Google Scholar 

  35. Peynircioglu B, Cwikiel W. Utility of stent-grafts in the treatment of porto-biliary fistula. Cardiovasc Intervent Radiol. 2006;29(6):1156–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, University of Chicago Medical Center, 5841 S. Maryland Ave. MC2026, Chicago, IL, 60037, USA

    Mikin V. Patel & Jonathan M. Lorenz

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  1. Mikin V. Patel
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  2. Jonathan M. Lorenz
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Correspondence to Jonathan M. Lorenz .

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Editors and Affiliations

  1. The University of Chicago, CHICAGO, Illinois, USA

    J. Michael Millis

  2. The University of Chicago, CHICAGO, Illinois, USA

    Jeffrey B. Matthews

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Patel, M.V., Lorenz, J.M. (2016). Management of Significant Hemobilia: Hepatic Artery Embolization or Stenting?. In: Millis, J., Matthews, J. (eds) Difficult Decisions in Hepatobiliary and Pancreatic Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-27365-5_30

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  • DOI: https://doi.org/10.1007/978-3-319-27365-5_30

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27363-1

  • Online ISBN: 978-3-319-27365-5

  • eBook Packages: MedicineMedicine (R0)

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