Minor hemobilia. Clinical significance and pathophysiological background

Area of Science:

• Gastroenterology
• Hepatobiliary Surgery
• Pathophysiology

Background:

• Minor hemobilia, frequently caused by gallstones or surgical injury, is often underestimated.
• Unlike major hemobilia, minor hemobilia can lead to complications such as diagnostic errors and bile duct obstruction due to clot formation.

Purpose of the Study:

• To investigate the pathophysiology of blood clot formation in minor hemobilia.
• To determine the clinical significance of blood clots formed in the biliary tract.

Main Methods:

• Constructed a biliary tract model to simulate major and minor hemobilia.
• Injected blood into the model to observe clot formation and dissolution under varying bile flow conditions.
• Induced blood clots in canine gallbladders to assess clot stability and adherence.

Main Results:

• Forceful blood injection created mixed bile-blood clots that dissolved, while gentle injection formed pure blood clots.
• Pure blood clots were solid and stable, especially when protected from bile flow, whereas mixed clots were mushy and dissolved.
• Canine gallbladder clots adhered to the mucosa; pure clots floated, mixed clots formed adherent layers, and both dissolved if bile flow was maintained.

Conclusions:

• Minor hemobilia can result in clinically significant blood clots that obstruct bile flow or cause diagnostic confusion.
• Blood clots in the biliary tract may be mistaken for gallstones, and their dissolution can be misinterpreted as "retained stone" clearance.
• The presence of blood clots should be considered in cases of biliary obstruction or cholangiographic defects, even without obvious hemorrhage.