," British Journal of Surgery, vol.
Costamagna, "Endoscopic treatment of extrahepatic bile duct strictures in patients with portal biliopathy carries a high risk of haemobilia
: report of 3 cases," Digestive and Liver Disease, vol.
Variations in the anatomy of gallbladder, bile ducts and the arteries that supply them and liver are important to the surgeon, because failure to recognize them may lead to inadvertent ductal ligation, biliary leaks, haemobilia
, haemorrhage and strictures after laparoscopic or open cholecystectomy and may complicate surgeries such as liver transplantation.
These include a number of specific anatomical regions, such as internal iliac and facial injuries, and traumatic haemobilia
. ([3-6]) Traumatic haemobilia
is a rare but potentially life-threatening complication that occurs in less than 3% of liver injuries and is associated with a reported operative mortality rate of 30%.
Causes of upper gastrointestinal bleeding-related degree of bleeding severity Site Degree of Oesophageal Gastric Duodenal bleeding Major common Oesophageal Gastric varices Benign ulcer varices Portal hypertensive Mallory-Weiss gastropathy tear Benign ulcer Major uncommon Dieulafoy's lesion Haemobilia
Haemosuccus pancreas Aorto-enteric fistula Gastric cancer Usually minor Oesophagitis Gastritis Oesophageal Gastric antral cancer vascular ectasia Table 2.
A case of acute cholecystitis secondary to haemobilia
after percutaneous liver biopsy.
Its reported accuracy in defining the level of obstruction is more than 90%.9,12 Complications include sepsis, bile leak, intra-peritoneal haemorrhage, haemobilia
, hepatic and perihepatic abscess, pneumothorax, skin infection and granuloma at the catheter entry site.
Changes in the transaminase and phosphatase activity of the blood and the occurrence of haemobilia
following experimental liver trauma in the rabbit.
However this proved to be ineffective (Figure 2), and so the posterior branch of the right hepatic artery was embolised, successfully controlling the haemobilia
. The left hepatic artery was spared.
Causes of upper gastrointestinal bleeding-related degree of bleeding severity Site Degree of Oesophageal Gastric Duodenal bleeding Major Oesophageal Gastric Benign ulcer common varices varices Mallory-Weiss Portal tear hypertensive gastropathy Benign ulcer Major Dieulafoy's Haemobilia
uncommon lesion Haemosuccus pancreas Aorto-enteric fistula Gastric cancer Usually Oesophagitis Gastritis minor Oesophageal Gastric antral cancer vascular ectasia Resuscitation and assessment
One gunshot victim had extravasation from the branch of right hepatic artery resulting in haemobilia
. He was cured with coil embolisation of the bleeding vessel.
In 56% of cases (3), rupture of the cystic artery pseudoaneurysm occurs at the vesicular lumen, which clinically presents as upper gastrointestinal bleeding due to haemobilia
. Therefore, the appearance of the classic triad of haemobilia
(abdominal pain, jaundice and upper gastrointestinal bleeding) in the context of a patient with symptoms of cholecystitis should suggest the possibility of an arterial pseudoaneurysm at the hepatic pedicle.