Radiological interventions for iatrogenic hemobilia: a single institution experience

To evaluate the safety and efficacy of radiological interventions for iatrogenic hemobilia.

This retrospective study included 53 patients (mean age: 44.9 years; 32 males, 21 females) who presented with hemorrhagic complications following hepatobiliary interventions (surgical, endoscopic, or radiological) and underwent percutaneous or endovascular embolization between January 2015 and May 2023. The patients were categorized into two groups: Group 1 included patients with a history of surgery, and Group 2 included patients with a history of non-surgical interventions. The clinical-data, imaging-findings, and details of embolization techniques were collected. Technical success and clinical success were assessed along with complications, recurrence, and mortality, and any predictive parameters for these outcomes. Statistical analysis was performed using chi-square and t-tests, with significance set at p ≤ 0.05.

The overall technical success of embolization was 100% and clinical success was 98.1%. There were 17 patients in group 1 and 36 patients in group 2 with a significantly higher incidence of gastrointestinal bleeding (64.7% vs. 19.4%, p = 0.007) and pseudoaneurysms (88.2% vs. 50%, p = 0.013) in group 1. Clinical success was 94.1% in group 1 and 100% in group 2 (p = 0.321). One patient in group 1 had recurrence after a week, which was successfully managed with direct percutaneous n-butyl cyanoacrylate glue embolization. There were no major procedure-related complications. The overall mortality-rate was 13.2% (7/53), with all deaths attributed to the underlying disease. Shock at presentation (p = 0.001) was the sole predictor of mortality on multivariate-analysis (Odds-Ratio = 25.8, Confidence-Interval = 2.2-298.0). No significant difference was observed in recurrence or mortality rates between both the groups.

Radiological interventions are effective and safe for managing iatrogenic hemobilia, with high technical and clinical success rates. Shock on presentation is an independent predictor of mortality, emphasizing the need for urgent and definitive hemostatic control with radiological interventions in such patients.