[The problem of hemobilia after transhepatic endobiliary interventions]

To study the causes of hemobilia occurring during percutaneous transhepatic drainage and to develop methods for its prevention.

Treatment results were analyzed in 149 patients with tumors in the hepatopancretoduodenal area. Among the examined patients, there were 65 (43.6%) males and 84 (56.4%) females at the age of 33 to 91 years (mean 64.1 years) who underwent 881 different endobiliary interventions. The condition was severe in 46 (30.9%) patients, moderate in 89 (59.7%), and satisfactory in 14 (9.4%). Extensive abdominal surgery had been performed in 71 (47.6%) cases. The preadmission history of mechanical jaundice was 7 to 30 days (mean 18.5 days). Total bilirubin levels were in the range from 32.9 to 726 μmol/l (mean 249.4 μmol/l). Philips Allura V 3000 and Siemens Axiom Artis devices were used to exercise X-ray TV control during the interventions.

The bile ducts were stented applying various models of expanding metallic stents in 93 (62.4%) of the 149 patients. A one-stage stenting protocol was used in 24 (25.8%) of the 93 patients and two-stage endobiliary stenting was carried out in 69 (74.2%). The other 56 (37.6%) of the 149 patients underwent only external-internal biliary drainage. Ten (6.7%) patients were noted to have different hemorrhagic complications as venous (4.7%, n = 7) and arterial (2%, n = 3) hemobilia.

X-ray surgical hemostatic procedures can ensure a final positive effect of transhepatic bile duct compression.