Biliary catheter drainage complicated by hemobilia: treatment by balloon embolotherapy

Seventeen patients experienced severe hemobilia following percutaneous (nine patients) or surgical (eight patients) placement of biliary drainage catheters. Fourteen patients bled early after catheter placement (0.5-32 weeks; mean, 5.4 weeks) and three bled late during long-term biliary drainage (1.1-3.6 years; mean, 2 years). Hepatic angiography demonstrated the source of bleeding in 15 (88%) patients (hepatic artery pseudoaneurysm in ten, hepatic artery-portal vein fistula in four, varix along the tube tract in one) but showed no source of bleeding in two. Thirteen patients with hemobilia were treated with embolotherapy, using detachable balloons in 12. The advantages of this technique included the ability to flow-direct the balloon without selective catheterization; the ability to test-inflate the balloon at the site of the aneurysm or fistula during angiographic study and adjust its position before detachment; and preservation of the hepatic artery proximal and distal to the inflated balloon, thus preserving hepatic function following embolization.