Hepatic haemobilia: non-operative management in eight cases

Eight cases of major haemobilia have been seen by the Surgical Hepatobiliary service at Westmead Hospital between 1979 and 1984. Two occurred following blunt abdominal trauma, three after percutaneous biliary drainage or liver biopsy, two in association with postoperative haemorrhagic pancreatitis and one because of an abscess complicating hepatic hydatid disease. Coeliac and superior mesenteric angiography were carried out in all patients, and false aneurysms were demonstrated in seven of the eight. A marked coagulopathy was present in the remaining patient, in whom bleeding stopped without intervention when the coagulopathy was reversed. Those with false aneurysms were treated by radiologically controlled transarterial embolization with gelfoam, acrylate or Gianturco coils, and bleeding was controlled in all. There was one death from overwhelming sepsis in the patient with the hepatic abscess. It is concluded that percutaneous radiologically controlled embolization is the treatment of choice for most cases of haemobilia, except when there is major hepatic sepsis.