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[Treatment of hemobilia after percutaneous transhepatic cholangiography and drainage (PTCD)]
O Takahara1, M Ichikawa, Y Hisanaga
1Department of Internal Medicine, Anjo Kosei Hospital.
Insights
Transcatheter anterior embolization (TAE) effectively treated hemobilia in patients undergoing percutaneous transhepatic cholangiography (PTCD). TAE, especially when applied to all hepatic arteries, ensured complete hemorrhage control, preventing rebleeding.
Area of Science:
- Interventional Radiology
- Hepatobiliary Medicine
- Vascular Interventions
Background:
- Percutaneous transhepatic cholangiography (PTCD) is an established procedure for biliary interventions.
- Hemobilia, or bleeding into the bile ducts, is a rare but serious complication of PTCD.
- Effective management strategies for PTCD-induced hemobilia are crucial.
Observation:
- This study reviewed 206 PTCD procedures over 6 years and 7 months.
- Hemobilia occurred in 14 patients (6.8%) following PTCD.
- Initial treatments included bile duct irrigation and catheter compression.
Findings:
- Transcatheter anterior embolization (TAE) was employed for refractory hemobilia cases.
- TAE, utilizing coils or sponges, achieved complete hemorrhage control in all treated patients.
- A protocol adjustment involved embolizing all hepatic arteries in patients with normal liver function and portal vein flow to prevent rebleeding.
Implications:
- TAE is a highly effective treatment for hemobilia complicating PTCD.
- Embolization of all hepatic arteries may be necessary for sustained hemostasis in select cases.
- This approach enhances patient safety and procedural success in interventional radiology.
Abstract:
PTCD was performed in 206 of our patients during the past 6 years and 7 months. Of the 206, hemobilia occurred in 14 patients (6.8%). The hemorrhage was completely stopped by irrigation of the bile duct in 3 patients, compression with a larger catheter in 7 patients, and transcatheter anterior embolization (TAE) in 4 patients. TAE was performed on the patients whose hemobilia could not controlled by the compression with a larger catheter. In TAE, either a steel coil or a sponge was used as an embolus. Rebleeding occurred in one patients for whom the right hepatic artery was chosen as a embolization site. Therefore, it was decided that the embolization was going to be done in all the hepatic arteries when the blood stream in the portal vein and preserved functions of the liver of the subjected patients including the one with rebleeding were fully normal. A complete control of the hemorrhage was obtained in all patients. The PTCD root caused hemobilia was removed after TAE in considering the possibility of rebleeding from the root, and a new PTCD root was made.