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Hemobilia complicating a liver abcess
Neeraj Awasthy1, Monica Juneja, Bibek Talukdar
1Department of Pediatrics, Maulana Azad Medical College and LNJP Hospital, Delhi - 110 029, India. n_awasthy@yahoo.com
Insights
This case study highlights a rare instance of hemobilia (bleeding into the biliary tract) in an 11-year-old girl, linked to liver abscesses. Prompt diagnosis and angiography-guided embolization were crucial for managing this severe gastrointestinal hemorrhage.
Area of Science:
- Gastroenterology
- Hepatology
- Interventional Radiology
Background:
- Hemobilia, a rare cause of upper gastrointestinal hemorrhage, is increasingly recognized due to invasive hepatobiliary procedures.
- While often iatrogenic, hemobilia associated with liver abscesses is infrequently reported.
Observation:
- An 11-year-old female presented with shock, abdominal pain, fever, hematemesis, and melena.
- Initial investigations revealed multiple liver abscesses; endoscopy ruled out upper GI sources.
- Endoscopic retrograde cholangiography confirmed biliary tract bleeding.
Findings:
- Angiography identified a communication between biliary radicles and hepatic vessels.
- Therapeutic embolization was successfully performed via angiography.
- The patient's presentation was attributed to hemobilia secondary to liver abscesses.
Implications:
- This case underscores the importance of considering hemobilia in patients with liver abscesses presenting with gastrointestinal bleeding.
- Timely diagnosis and intervention, including angiography and embolization, are critical for managing severe hemobilia.
- Further research into non-iatrogenic causes of hemobilia, particularly those linked to hepatic abscesses, is warranted.
Abstract:
We present the case of an 11-year-old female, with a history of colicky pain abdomen fever, and episode of massive hematemesis and melena. The child was presented to the medical emergency with features of shock. Coagulation profile of the child was normal. Ultrasonography demonstrated multiple liver abscess. Repeated endoscopies ruled out the possibility of gastric or upper gastrointestinal causes of bleed where in the possibility of hemobilia, was considered. Endoscopic retrograde cholangiography demonstrated the presence of bleeding from the biliary tract. Angiography demonstrated the presence of the communication of the biliary radicles with the hepatic vessels and also aided with therapeutic embolization. Hemobilia is a rare cause of upper gastrointestinal hemorrhage with an increasing incidence because of the widespread use of invasive hepatobiliary procedures and improved recognition. In the majority of cases the cause is iatrogenic and those associated with the liver abscess are scantily reported in the English literature. Persistent bleeding sometimes requires urgent therapeutic intervention, such as angiography or surgery.
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