Hepatic artery angiography and embolization for hemobilia after hepatobiliary surgery

To evaluate the effectiveness of hepatic angiography and embolization in the diagnosis and treatment of hemobilia after hepatobiliary surgery.

Nine patients had upper gastrointestinal bleeding 7 days to 3 months after surgery. They underwent emergency hepatic artery angiography and were treated by embolization using Gelfoam particles only (8 patients) and Gelfoam particles plus microcoils (1 patient).

Hepatic artery angiography revealed hepatic artery pseudoaneurysms in 3 patients, diffuse hemorrhage of the hepatic artery branches in 3, right hepatic artery-bile duct fistulas in 2, and hepatic artery-small intestine fistula in 1. Hemobilia was controlled with embolization in 7 patients, of whom 1 had recurrent bleeding 1 day after treatment. During the follow-up, 3 patients died of multiple organ dysfunction syndrome. Two patients whose hemorrhage could not be controlled due to technical reasons died several days later.

When hemobilia after hepatobiliary surgery is suspected, patients should receive hepatic angiography as a first diagnostic procedure and be treated with minimally invasive procedure of selective embolization of the involved artery as soon as possible.