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Haemorrhage in bile
Haemobilia is a medical condition of bleeding into the biliary tree. Haemobilia occurs when there is a fistula between a vessel of the splanchnic circulation and the intrahepatic or extrahepatic 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.
- Trauma, accidental or iatrogenic e.g. due to procedures like cholecystectomy
- Instrumentation e.g. after ERCP
- Inflammatory conditions ranging from ascariasis to PAN
- Vascular malformation
- Liver biopsy
It can be immediately life threatening in major bleeding. However, in minor haemobilia, patient is haemodynamically stable despite significant blood loss being apparent.
Combination of OGD, CT scan and angiography 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 if ERCP is undertaken.
Most bleeding from instrumentation are minor and would settle spontaneously.
When indicated, management is directed towards stopping bleeding and relieving obstruction if present, which is achieved either by surgical ligation of hepatic artery or by endoscopic embolisation. Endoscopic trans-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.
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- Sargent, Suzanne (2009). Liver Diseases; An essential guide for nurses and healthcare professionals. Willey-Blackwell. pp. 24–25.
- Quincke, H. (1871). "Ein Fall von Aneurysma der Leberarterie". Berl Klin Wochenschr 30: 349–352.
- Green M, Duell R, Johnson C, Jamieson N (2001). "Haemobilia". The British journal of surgery 88 (6): 773–86. doi:10.1046/j.1365-2168.2001.01756.x. PMID 11412246.