Iatrogenic hemobilia

Biliary tract hemorrhage is increasingly reported as a complication of diagnostic and therapeutic interventions on the liver and the bile ducts. Major hemobilia with profuse, even life-threatening, hemorrhage which necessitates emergency surgical intervention is uncommon. Minor hemobilia with melena or clot production in the ducts, although more common, may cause diagnostic difficulties. Diagnosis is obtained either endoscopically to demonstrate bleeding through the papilla of Vater, or through hepatic arteriography, which has the advantage of indicating the location of the lesion. Operative treatment with resection of the lesion or ligature of the hepatic artery or a branch has been replaced by embolization of the affected artery. Diagnostic procedures that may cause hemobilia include percutaneous needle biopsy and transhepatic cholangiography. The risk of hemorrhage increases if a catheter is left in place for drainage. Difficult extractions of common duct stones may cause hemorrhage due to lesions of the vulnerable duct mucosa. Finally, spontaneous hemobilia may, like hematuria or epistaxis, be caused by an overdose of anticoagulants.