1
|
Schütz ŠO, Rousek M, Pudil J, Záruba P, Malík J, Pohnán R. Delayed Post-Traumatic Hemobilia in a Patient With Blunt Abdominal Trauma: A Case Report and Review of the Literature. Mil Med 2023; 188:3692-3695. [PMID: 35894601 DOI: 10.1093/milmed/usac230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/22/2022] [Accepted: 07/20/2022] [Indexed: 11/12/2022] Open
Abstract
Hemobilia is a rare condition defined as bleeding in the biliary tract. The clinical presentation is variable. The typical manifestation consists of jaundice, upper gastrointestinal bleeding, and right upper quadrant abdominal pain. This set of symptoms is known as "Quincke's triad." It is present in only 22%-35% of cases. Post-traumatic hemobilia is an extraordinarily rare condition occurring in only 6% of the patients with hemobilia. In general, it occurs in less than 0.2% of patients with liver trauma. A delay in the development of bleeding after liver trauma is frequent. Early diagnosis is essential because massive bleeding into the biliary tract is a potentially life-threatening condition. We present a case of a patient with massive hemobilia developed 12 days after blunt abdominal trauma. Computed tomography angiography showed two pseudoaneurysms in hepatic segments V and VIII with contrast medium extravasation. We successfully performed digital subtraction angiography with selective transcatheter arterial embolization of the leaking segment VIII pseudoaneurysm. Embolization of the pseudoaneurysm in segment V was technically impracticable. Our article provides a review of the published literature focussing on the prevalence, diagnostics, and treatment of post-traumatic hemobilia.
Collapse
Affiliation(s)
- Štěpán-Ota Schütz
- Department of Surgery, Second Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, 16902, Czech Republic
| | - Michael Rousek
- Department of Surgery, Second Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, 16902, Czech Republic
| | - Jiří Pudil
- Department of Surgery, Second Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, 16902, Czech Republic
| | - Pavel Záruba
- Department of Surgery, Second Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, 16902, Czech Republic
| | - Jozef Malík
- Department of Radiology, Military University Hospital Prague, Prague, 16902, Czech Republic
| | - Radek Pohnán
- Department of Surgery, Second Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, 16902, Czech Republic
| |
Collapse
|
2
|
Li H, Ge N, He C, Wang X, Xu W, Huang J, Yang Y. Portal vein embolization in the treatment of portal vein bleeding after percutaneous transhepatic biliary drainage: A case report and literature review. J Interv Med 2022; 5:217-220. [DOI: 10.1016/j.jimed.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/26/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022] Open
|
3
|
Shi Y, Chen L, Zhao B, Huang H, Lu Z, Su H. Transcatheter arterial embolization for massive hemobilia with N-butyl cyanoacrylate (NBCA) Glubran 2. Acta Radiol 2022; 63:360-367. [PMID: 33562997 DOI: 10.1177/0284185121992971] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Massive hemobilia is a life-threatening condition and therapeutic challenge. Few studies have demonstrated the use of N-butyl cyanoacrylate (NBCA) for massive hemobilia. PURPOSE To investigate the efficacy and safety of transcatheter arterial embolization (TAE) using NBCA Glubran 2 for massive hemobilia. MATERIAL AND METHODS Between January 2012 and December 2019, the data of 26 patients (mean age 63.4 ± 12.6 years) with massive hemobilia were retrospectively evaluated for TAE using NBCA. The patients' baseline characteristics, severities of hemobilia, and imaging findings were collected. Emergent TAE was performed using 1:2-1:4 mixtures of NBCA and ethiodized oil. Technical success, clinical success, procedure-related complications, and follow-up outcomes were assessed. RESULTS Pre-procedure arteriography demonstrated injuries to the right hepatic artery (n = 24) and cystic artery (n = 2). Initial coil embolization distal to the lesions was required in 5 (19.2%) patients to control high blood flow and prevent end-organ damage. After a mean treatment time of 11.2 ± 5.3 min, technical success was achieved in 100% of the patients without non-target embolization and catheter adhesion. Clinical success was achieved in 25 (96.2%) patients. Major complications were noted in 1 (3.8%) patient with gallbladder necrosis. During a median follow-up time of 16.5 months (range 3-24 months), two patients died due to carcinomas, whereas none of the patients experienced recurrent hemobilia, embolic material migration, or post-embolization complications. CONCLUSION NBCA embolization for massive hemobilia is associated with rapid and effective hemostasis, as well as few major complications. This treatment modality may be a promising alternative to coil embolization.
Collapse
Affiliation(s)
- Yadong Shi
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
| | - Liang Chen
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
| | - Boxiang Zhao
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
| | - Hao Huang
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
| | - Zhaoxuan Lu
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
| | - Haobo Su
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
| |
Collapse
|
4
|
Kurniawan K, Wibawa IDN, Somayana G, Mariadi IK, Mulyawan IM. Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report. J Med Case Rep 2021; 15:331. [PMID: 34210350 PMCID: PMC8252212 DOI: 10.1186/s13256-021-02915-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/18/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hemobilia is a rare cause of upper gastrointestinal bleeding that originates from the biliary tract. It is infrequently considered in diagnosis, especially in the absence of abdominal trauma or history of hepatopancreatobiliary procedure, such as cholecystectomy, which can cause arterial pseudoaneurysm. Prompt diagnosis is crucial because its management strategy is distinct from other types of upper gastrointestinal bleeding. Here, we present a case of massive hemobilia caused by the rupture of a gastroduodenal artery pseudoaneurysm in a patient with a history of laparoscopic cholecystectomy 3 years prior to presentation. CASE PRESENTATION A 44-year-old Indonesian female presented to the emergency department with complaint of hematemesis and melena accompanied by abdominal pain and icterus. History of an abdominal trauma was denied. However, she reported having undergone a laparoscopic cholecystectomy 3 years prior to presentation. On physical examination, we found anemic conjunctiva and icteric sclera. Nonvariceal bleeding was suspected, but esophagogastroduodenoscopy showed a blood clot at the ampulla of Vater. Angiography showed contrast extravasation from a gastroduodenal artery pseudoaneurysm. The patient underwent pseudoaneurysm ligation and excision surgery to stop the bleeding. After surgery, the patient's vital signs were stable, and there was no sign of rebleeding. CONCLUSION Gastroduodenal artery pseudoaneurysm is a rare complication of laparoscopic cholecystectomy. The prolonged time interval, as compared with other postcholecystectomy hemobilia cases, resulted in hemobilia not being considered as an etiology of the gastrointestinal bleeding at presentation. Hemobilia should be considered as a possible etiology of gastrointestinal bleeding in patients with history of cholecystectomy, regardless of the time interval between the invasive procedure and onset of bleeding.
Collapse
Affiliation(s)
- Kurniawan Kurniawan
- Department of Internal Medicine, Faculty of Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - I Dewa Nyoman Wibawa
- Gastroentero-Hepatology Division, Department of Internal Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - Gde Somayana
- Gastroentero-Hepatology Division, Department of Internal Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - I Ketut Mariadi
- Gastroentero-Hepatology Division, Department of Internal Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia.
| | - I Made Mulyawan
- Digestive Surgery Division, Department of General Surgery, Faculty of Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia
| |
Collapse
|
5
|
Staszak JK, Buechner D, Helmick RA. Cholecystitis and hemobilia. J Surg Case Rep 2019; 2019:rjz350. [PMID: 31857891 PMCID: PMC6911657 DOI: 10.1093/jscr/rjz350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/01/2019] [Accepted: 10/31/2019] [Indexed: 12/13/2022] Open
Abstract
Hemobilia, or hemorrhage into the biliary system, is an unusual cause of gastrointestinal bleeding most commonly seen in accidental or iatrogenic trauma. We present the rare case of a 43-year-old gentleman who presents with an intrahepatic pseudoaneurysm caused by cholecystitis. The management of the hemobilia was technically challenging requiring multiple interventional procedures. We review the pathophysiology and treatment strategies for this rare case of gastrointestinal hemorrhage.
Collapse
Affiliation(s)
- Jessica K Staszak
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - David Buechner
- Department of Interventional Radiology, Memphis Radiological Professional Corp, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Ryan A Helmick
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38163, USA.,James D Eason Transplant Institute at Methodist University Hospital, Memphis, TN 38104, USA
| |
Collapse
|
6
|
Lal R, Yachha SK, Mandelia A, Dhoat N, Prakash D, Sen Sarma M, Yadav RR, Srivastava A, Poddar U, Behari A. Non-variceal gastrointestinal bleed in children: surgical experience with emphasis on management challenges. Pediatr Surg Int 2019; 35:1197-1210. [PMID: 31300851 DOI: 10.1007/s00383-019-04522-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE This exclusively surgical series on pediatric non-variceal gastrointestinal bleed (NVGIB) defines three levels of bleed site and describes etiology, bleed severity, diagnostic algorithm, and surgical management for each bleed site. Management challenges are detailed. METHODS Patients aged ≤ 18 years treated surgically for NVGIB were analysed. RESULTS Bleed site (n = 87) was classified as: upper gastrointestinal bleed (UGIB; n = 11); small bowel bleed (SBB: n = 52); and lower GIB (n = 24). Four etiology-based groups were identified: lesions with ectopic gastric mucosa (EGM; n = 33), tumours (n = 23), ulcers (n = 21), and vascular pathology (n = 8). Bleed severity spectrum was: acute severe bleed (n = 12); subacute overt bleed (n = 59); and occult GIB (n = 16). Preoperative diagnosis was obtained in all UGIB and LGIB lesions. Eighty-two percent of surgical SB lesions were diagnosed preoperatively on Tc99m pertechnetate scan, computed tomography enterography-angiography, and capsule endoscopy; remaining 18% were diagnosed at laparotomy with intra-operative enteroscopy (IOE). Surgical management was tailored to bleed site, severity, and etiology. Indications of IOE and approach to management challenges are detailed. CONCLUSIONS The commonest site-specific bleed etiologies were duodenal ulcers for UGIB, EGM lesions for SBB, and tumours for LGIB. SBB presented diagnostic challenge. Diagnostic algorithm was tailored to bleed site, age-specific etiology, bleed severity, and associated abdominal/systemic symptoms. Management challenges were acute severe bleed, occult GIB, SBB, obscure GIB, and rare etiologies. IOE has a useful role in SBB management.
Collapse
Affiliation(s)
- Richa Lal
- Department of Pediatric Surgical Superspecialties, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India.
| | - Surender K Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Ankur Mandelia
- Department of Pediatric Surgical Superspecialties, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Navdeep Dhoat
- Department of Pediatric Surgical Superspecialties, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Divya Prakash
- Department of Pediatric Surgical Superspecialties, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Rajanikant R Yadav
- Department of Radio-diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Anu Behari
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| |
Collapse
|
7
|
Zhornitskiy A, Berry R, Han JY, Tabibian JH. Hemobilia: Historical overview, clinical update, and current practices. Liver Int 2019; 39:1378-1388. [PMID: 30932305 DOI: 10.1111/liv.14111] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 12/16/2022]
Abstract
Hemobilia refers to macroscopic blood in the lumen of the biliary tree. It represents an uncommon, but important, cause of gastrointestinal bleeding and can have potentially lethal sequelae if not promptly recognized and treated. The earliest known reports of hemobilia date to the 17th century, but due to the relative rarity and challenges in diagnosis of hemobilia, it has historically not been well-studied. Until recently, most cases of hemobilia were due to trauma, but the majority now occur as a sequela of invasive procedures involving the hepatopancreatobiliary system. A triad (Quincke's) of right upper quadrant pain, jaundice and overt gastrointestinal bleeding has been classically described in hemobilia, but it is present in only a minority of patients. Therefore, prompt diagnosis depends critically on a high index of suspicion based on a patient's clinical presentation and a history of recently undergoing hepatopancreatobiliary intervention or having other predisposing factors. Treatment of hemobilia depends on the suspected source and clinical severity and thus ranges from supportive medical care to urgent advanced endoscopic, interventional radiologic, or surgical intervention. In the present review, we provide a historical perspective, clinical update and overview of current trends and practices pertaining to hemobilia.
Collapse
Affiliation(s)
- Alex Zhornitskiy
- Department of Internal Medicine, UCLA-Olive View Medical Center, Sylmar, California
| | - Rani Berry
- Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - James Y Han
- Department of Internal Medicine, University of California, Irvine, California
| | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California
| |
Collapse
|
8
|
Berry R, Han JY, Kardashian AA, LaRusso NF, Tabibian JH. Hemobilia: Etiology, diagnosis, and treatment ☆. LIVER RESEARCH 2018; 2:200-208. [PMID: 31308984 PMCID: PMC6629429 DOI: 10.1016/j.livres.2018.09.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hemobilia refers to bleeding from and/or into the biliary tract and is an uncommon but important cause of gastrointestinal hemorrhage. Reports of hemobilia date back to the 1600s, but due to its relative rarity and challenges in diagnosis, only in recent decades has hemobilia been more critically studied. The majority of cases of hemobilia are iatrogenic and caused by invasive procedures involving the liver, pancreas, bile ducts and/or the hepatopancreatobiliary vasculature, with trauma and malignancy representing the two other leading causes. A classic triad of right upper quadrant pain, jaundice, and overt upper gastrointestinal bleeding has been described (i.e. Quincke's triad), but this is present in only 25%-30% of patients with hemobilia. Therefore, prompt diagnosis depends critically on having a high index of suspicion, which may be based on a patient's clinical presentation and having recently undergone (peri-) biliary instrumentation or other predisposing factors. The treatment of hemobilia depends on its severity and suspected source and ranges from supportive care to advanced endoscopic, interventional radiologic, or surgical intervention. Here we provide a clinical overview and update regarding the etiology, diagnosis, and treatment of hemobilia geared for specialists and subspecialists alike.
Collapse
Affiliation(s)
- Rani Berry
- Department of Internal Medicine, UCLA Ronald Reagan Medical Center, Los Angeles, CA, USA
| | - James Y. Han
- Department of Internal Medicine, University of California Irvine, Irvine, CA, USA
| | - Ani A. Kardashian
- UCLA Gastroenterology Fellowship Training Program, Vatche and Tamar Manoukian Division of Digestive Diseases, Los Angeles, CA, USA
| | - Nicholas F. LaRusso
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - James H. Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA,Corresponding author. Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA., (J. H. Tabibian)
| |
Collapse
|
9
|
Berry R, Han J, Girotra M, Tabibian JH. Hemobilia: Perspective and Role of the Advanced Endoscopist. Gastroenterol Res Pract 2018; 2018:3670739. [PMID: 30116262 PMCID: PMC6079575 DOI: 10.1155/2018/3670739] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/23/2018] [Indexed: 12/17/2022] Open
Abstract
Hemobilia refers to bleeding from and/or into the biliary tract and is an uncommon cause of gastrointestinal hemorrhage. Hemobilia has been documented since the 1600s, but due to its relative rarity, it has only been more critically examined in recent decades. Most cases of hemobilia are iatrogenic and caused by procedures involving the liver, pancreas, bile ducts, and/or the hepatopancreatobiliary vasculature, with trauma and malignancy representing the two other major causes. A classic triad of right upper quadrant pain, jaundice, and overt upper gastrointestinal bleeding has been described, but this is present in only 25-30% of patients with hemobilia. Historically, the gold standard for diagnosis and treatment has been angiography and interventional radiologic intervention, respectively. However, the paradigm is shifting, at least in select cases, towards first-line reliance on noninvasive imaging (e.g., computed tomography) and therapeutic endoscopy, owing to advances in and the less invasive nature of both, while saving interventional radiological and/or surgical intervention for refractory or imminently life-threatening cases.
Collapse
Affiliation(s)
- Rani Berry
- Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - James Han
- Department of Internal Medicine, University of California, Irvine, CA, USA
| | - Mohit Girotra
- Division of Gastroenterology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - James H. Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| |
Collapse
|
10
|
Cathcart S, Birk JW, Tadros M, Schuster M. Hemobilia: An Uncommon But Notable Cause of Upper Gastrointestinal Bleeding. J Clin Gastroenterol 2017. [PMID: 28644311 DOI: 10.1097/mcg.0000000000000876] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
GOAL AND BACKGROUND A literature review to improve practitioners' knowledge and performance concerning the epidemiology, diagnosis, and management of hemobilia. STUDY A search of Pubmed, Google Scholar, and Medline was conducted using the keyword hemobilia and relevant articles were reviewed and analyzed. The findings pertaining to hemobilia etiology, investigation, and management techniques were considered and organized by clinicians practiced in hemobilia. RESULTS The majority of current hemobilia cases have an iatrogenic cause from either bile duct or liver manipulation. Blunt trauma is also a significant cause of hemobilia. The classic triad presentation of right upper quadrant pain, jaundice, and upper gastrointestinal bleeding is rarely seen. Computed tomography and magnetic resonance imaging are the preferred diagnostic modalities, and the preferred therapeutic management includes interventional radiology and endoscopic retrograde cholangiopancreatography. Surgery is rarely a therapeutic option. CONCLUSIONS With advances in computed tomography and magnetic resonance imaging technology, diagnosis with these less invasive investigations are the favored option. However, traditional catheter angiography is still the gold standard. The management of significant hemobilia is still centered on arterial embolization, but arterial and biliary stents have become accepted alternative therapies.
Collapse
Affiliation(s)
- Scott Cathcart
- *Albany Medical Center, Albany Medical College Departments of §Radiology ‡Gastroenterology & Hepatology, Albany Medical Center, Albany, NY †Division of Gastroenterology & Hepatology, Gastroenterology & Hepatology Fellowship Program, UConn School of Medicine, Farmington, CT
| | | | | | | |
Collapse
|
11
|
Lozano-Cruz P, Arenas P, Moral I. Hemobilia related to cystic artery pseudoaneurysm as a cause of acute pancreatitis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 109:316. [PMID: 28229613 DOI: 10.17235/reed.2017.4532/2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hemobilia is a rare cause of upper gastrointestinal bleeding (UGIB). It is commonly iatrogenic, and is more rarely caused by tumors, lithiasis, and inflammatory or vascular disease. We describe a case of cystic artery pseudoaneurysm, which caused acute pancreatitis as an unusual complication.
Collapse
Affiliation(s)
| | - Percy Arenas
- Radiodiagnóstico, Hospital Universitario Príncipe de Asturias
| | - Ignacio Moral
- Aparato Digestivo, Hospital Universitario Príncipe de Asturias
| |
Collapse
|
12
|
Transjugular Liver Biopsy and the Bloody Mess That Follows: A Rare Case of Hemobilia and Hemocholecystitis. ACG Case Rep J 2016; 3:e108. [PMID: 27807570 PMCID: PMC5062652 DOI: 10.14309/crj.2016.81] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 02/01/2016] [Indexed: 11/17/2022] Open
|
13
|
Dale AP, Khan R, Mathew A, Hersey NO, Peck R, Lee F, Goode SD. Hepatic Tract Plug-Embolisation After Biliary Stenting. Is It Worthwhile? Cardiovasc Intervent Radiol 2015; 38:1244-51. [PMID: 25762487 DOI: 10.1007/s00270-015-1058-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 01/19/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE PTC and stenting procedures are associated with significant risks including life-threatening haemorrhage, sepsis, renal failure and high mortality rates. PTC tract closure methods are utilised to reduce haemorrhagic complications despite little evidence to support their use. The current study assesses the incidence of haemorrhagic complications following PTC and stenting procedures, both prior to and following the introduction of a dedicated expanding gelatin foam-targeted embolisation liver tract closure technique. MATERIALS AND METHODS Haemorrhagic complications were retrospectively identified in patients undergoing PTC procedures both prior to (subgroup 1) and following (subgroup 2) the introduction of a dedicated targeted liver tract closure method between 9/11/2010 and 10/08/2012 in a single tertiary referral centre. Mean blood Hb decrease following PTC was established in subgroups 1 and 2. Kaplan-Meier life-table analysis was performed to compare survival outcomes between subgroups using the log-rank test. RESULTS Haemorrhagic complications were significantly reduced following the introduction of the targeted PTC tract closure method [(12 vs. 3 % of subgroups 1 (n = 101) and 2 (n = 92), respectively (p = 0.027)]. Mean blood Hb decrease following PTC was 1.40 versus 0.68 g/dL in subgroups 1 and 2, respectively (p = 0.069). 30-day mortality was 14 and 12 % in subgroups 1 and 2, respectively. 50 % of the entire cohort had died by 174 days post-PTC. CONCLUSION Introduction of liver tract embolisation significantly reduced haemorrhagic complications in our patient cohort. Utilisation of this method has the potential to reduce the morbidity and mortality burden associated with post-PTC haemorrhage by preventing bleeding from the liver access tract.
Collapse
Affiliation(s)
- Adam P Dale
- Department of Medical Microbiology, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, UK.
| | - Rafeh Khan
- Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Anup Mathew
- Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Naomi O Hersey
- Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Robert Peck
- Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Frederick Lee
- Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Stephen D Goode
- Sheffield Vascular Institute, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| |
Collapse
|
14
|
Interventional therapy for the treatment of severe hemobilia after percutaneous transhepatic cholangial drainage: a case series. Int Surg 2014; 98:223-8. [PMID: 23971775 DOI: 10.9738/intsurg-d-13-cc194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
From May 2003 to May 2010, a total of 9 patients with severe hemobilia after percutaneous transhepatic cholangial drainage (PTCD) were diagnosed using superselective angiography and cholangiography, and then were treated with interventional procedures. Two patients with hepatic arterio-biliary fistula underwent proximal and distal arterial embolization of the responsible vessel. Six patients with pseudoaneurysm had pseudoaneurysm occlusion with proximal and distal embolization. Another patient with biliary-portal vein fistula received a biliary fully covered stent placement. The effects in these patients were evaluated using superselective angiography immediately after the intervention and at 3- and 6-month follow-up. In all patients, hemobilia was stopped right after the treatment and no sign of recurrence was noted at 3- and 6-month follow-up after the interventional therapy. Our findings demonstrate that interventional therapy is a simple, minimally invasive, and safe approach for treating severe hemobilia in patients receiving PTCD.
Collapse
|
15
|
Zhang GW, Lin JH, Qian JP, Zhou J. Identification of risk factors for intraoperative hemobilia and its correlation with early postoperative complications in patients with hepatolithiasis. Am J Surg 2014; 209:260-7. [PMID: 25190546 DOI: 10.1016/j.amjsurg.2014.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 05/04/2014] [Accepted: 05/15/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND This study intends to determine the risk factor(s) for intraoperative hemobilia in patients with hepatolithiasis and examine whether the occurrence of intraoperative hemobilia influences the rate of early postoperative complications. METHODS A retrospective analysis of 867 eligible patients was performed. Patients were divided into 2 groups: group A (hemobilia, n = 76) and group B (nonhemobilia, n = 791). RESULTS The incidence of intraoperative hemobilia was 8.8% (76/867). Independent risk factors of intraoperative hemobilia for patients with hepatolithiasis were interval between surgery and latest attack of acute cholangitis less than or equal to 38.8 days; preoperative attack of acute severe cholangitis; and intrahepatic duct stricture. Group A had a higher incidence of early postoperative complications than group B. Shorter interval between surgery and latest attack of acute cholangitis correlated with intraoperative hemobilia and postoperative complications. CONCLUSION The severity and time of onset of preoperative acute cholangitis influence the risk of intraoperative hemobilia, which is positively correlated with early postoperative complications.
Collapse
Affiliation(s)
- Guo-wei Zhang
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou 510515, China.
| | - Jian-hua Lin
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou 510515, China
| | - Jian-ping Qian
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou 510515, China
| | - Jie Zhou
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou 510515, China
| |
Collapse
|
16
|
Yoshida RY, Kariya S, Nakatani M, Komemushi A, Kono Y, Tanigawa N. Direct puncture embolization using N-butyl cyanoacrylate for a hepatic artery pseudoaneurysm. MINIM INVASIV THER 2013; 23:110-4. [PMID: 24171455 DOI: 10.3109/13645706.2013.841252] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Massive hemobilia caused by hepatic artery pseudoaneurysm is an uncommon but potentially fatal complication that can occur after biliary intervention. Previous intervention or surgery, atherosclerotic disease, inflammation and even anatomic variants may make the pseudoaneurysm inaccessible to transcatheter approach, therefore it is not always feasible. The present report describes a case of successful embolization of a hepatic artery pseudoaneurysm with N-butyl cyanoacrylate via direct puncture as an alternative approach. The case presentation is followed by the technical points and the properties of N-butyl cyanoacrylate that are particularly advantageous for use in direct puncture procedures.
Collapse
Affiliation(s)
- Rie Yagi Yoshida
- Department of Radiology, Kansai Medical University , Osaka , Japan
| | | | | | | | | | | |
Collapse
|
17
|
Koh PS, Yoong BK, Vijayananthan A, Nawawi O, Mahadeva S. Jaundice and life-threatening hemobilia: an uncommon presentation of choledochal cyst. J Dig Dis 2013; 14:451-4. [PMID: 23324023 DOI: 10.1111/1751-2980.12036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hemobilia with jaundice as a result of cholestasis and bleeding from choledochal cyst is uncommon. Ascertaining the diagnosis is often challenging and delayed diagnosis can lead to significant consequences due to hemodynamic instability, particularly in elderly patients. Although surgery remains the definitive treatment modality, interventional radiology for hemostasis has been increasingly recognized as an option. In this manuscript, we described two Malaysian cases of jaundice and hemobilia associated with choledochal cysts and the challenges related with clinical diagnosis and management.
Collapse
Affiliation(s)
- Peng Soon Koh
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia.
| | | | | | | | | |
Collapse
|