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Massive Hemobilia: A Diagnostic and Therapeutic Challenge

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Abstract

Background

Massive hemobilia is a rare but potentially life-threatening cause of upper gastrointestinal hemorrhage. In this retrospective analysis, we have evaluated the challenges involved in the diagnosis and management of massive hemobilia.

Methods

Between 2001 and 2011, a total of 20 consecutive patients (14 males) who were treated in our department for massive hemobilia were included in the study and their records were retrospectively analyzed.

Results

Causes of hemobilia were blunt liver trauma (n = 9), hepatobiliary intervention (n = 4), post-laparoscopic cholecystectomy hepatic artery pseudoaneurysm (n = 3), hepatobiliary tumors (n = 3), and vascular malformation (n = 1). Melena, abdominal pain, hematemesis, and jaundice were the leading symptoms. All patients had undergone upper GI endoscopy, abdominal ultrasound, and computerized tomography of the abdomen. An angiogram and therapeutic embolization were done in 12 patients and was successful in nine but failed in three, requiring surgery. Surgical procedures performed were right hepatectomy (n = 4), extended right hepatectomy (n = 1), segmentectomy (n = 1), extended cholecystectomy (n = 1), repair of the pseudoaneurysm (n = 3), and right hepatic artery ligation (n = 1).

Conclusion

The successful diagnosis of hemobilia depends on a high index of suspicion for patients with upper GI bleeding and biliary symptoms. Although transarterial embolization is the therapeutic option of choice for massive hemobilia, surgery has a definitive role in patients with hemodynamic instability, after failed embolization, and in patients requiring laparotomy for other reasons.

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Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Authors and Affiliations

  1. Institute of Surgical Gastroenterology and Liver Transplantation, Government Stanley Medical College, Chennai, 600001, India

    Satish Devakumar Murugesan, Jeswanth Sathyanesan, Anand Lakshmanan, Sukumar Ramaswami, Senthilkumar Perumal, Srinivasan Ulagendra Perumal, Ravi Ramasamy & Ravichandran Palaniappan

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  1. Satish Devakumar Murugesan
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  2. Jeswanth Sathyanesan
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Correspondence to Satish Devakumar Murugesan.

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Devakumar Murugesan, S., Sathyanesan, J., Lakshmanan, A. et al. Massive Hemobilia: A Diagnostic and Therapeutic Challenge. World J Surg 38, 1755–1762 (2014). https://doi.org/10.1007/s00268-013-2435-5

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