[Therapeutic approach to hemobilia]

Hemobilia, defined as hemorrhage arising from pathological changes in the biliary tract, represents a rare entity. In a retrospective study the presentation, diagnosis, and management of hemobilia were investigated.

Since January 1991 six patients suffering from severe hemobilia presented to our department. Jaundice, right upper quadrant abdominal pain, hematemesis and melaena were the most frequent symptoms leading to admission. Hemobilia originated from iatrogenic injury following percutaneous liver biopsy and endoscopic removal of common bile duct stones, and malignant hepatic or biliary tumors. Duodenoscopy revealed bleeding from the papilla in all patients. Diagnosis was confirmed by ERCP in all patients and angiography in 5 of 6 patients.

Angiographic occlusion of an arterial lesion with coils was successfully achieved in one patient. One patient was treated conservatively. In 3 patients liver resections were performed to control bleeding and the underlying tumorous pathology. In another patient, operative ligation of the supplying artery had to be performed. Within a minimum follow-up of six months none of the six patients showed recurrence of hemobilia.

Considering the impact of etiologic, diagnostic and therapeutic aspects in treatment of hemobilia we suggest an algorithm for a rational approach to hemobilia. Angiographic occlusion may control the bleeding and improve the patient's general condition. Definitive surgical treatment of hemobilia is safe and effective.