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Biliary hemorrhage may occur in a variety of clinical settings, but spontaneous hemobilia has not been reported from a cirrhotic liver. We describe a case of major hepatic hemobilia in a patient with cirrhosis and no history of trauma. A 50-year-old woman had abdominal pain, melena, and profound anemia. An extensive workup did not show the site of bleeding but did show a mass in the gallbladder. Cholecystectomy was performed, and at operation the patient was found to have cirrhosis and portal hypertension. The gallbladder “mass” was simply an organized clot, and hemorrhage recurred postoperatively. On reoperation, bleeding from the ampulla of Vater was observed, confirming the diagnosis of hemobilia. She was treated with angiographic interruption of hepatic arterial flow, at which time bleeding ceased. Her total transfusion requirements included 46 units of blood. Through 16 months of follow-up the patient has had no recurrent bleeding and no evidence of encephalopathy. This case demonstrates that spontaneous hemobilia may indeed arise from a cirrhotic liver. Proximal interruption of arterial flow is usually not recommended for hemobilia, especially in the presence of portal hypertension and cirrhosis, but may be life-saving in selected patients.
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- Hemorrhage into the biliary tract following trauma.“Traumatic Hemobilia”. Surgery. 1948; 24: 571-586
- Hemobilia (biliary tract hemorrhage) history, pathology, diagnosis, treatment.Charles C. Thomas, Springfield, Ill1972
- Hepatic hemobilia of traumatic or iatrogenic origin: recent advances in diagnosis and therapy: review of the literature from 1976 to 1981.World J Surg. 1984; 8: 2-8
- Hemobilia: review of recent experience with a worldwide problem.Am J Gastroenterol. 1987; 82: 448-453
- Late complications of central liver injuries.Surgery. 1982; 92: 733-743
- Amebic liver abscess with hemobilia.Am J Surg. 1979; 138: 453-455
- Hemobilia secondary to metastic liver disease.Gastroenterology. 1979; 76: 595-598
- Report of a rare case of significant hemobilia and a review of this entity.J Med. 1982; 13: 323-338
- Hemobilia secondary to percutaneous liver biopsy.Arch Intern Med. 1972; 130: 396-400
- Traumatic hemobilia: a complication of percutaneous liver biopsy.Gastroenterology. 1977; 72: 941-944
- Hemobilia after percutaneous transhepatic biliary drainage.Arch Surg. 1980; 115: 161-164
- Management of hemobilia associated with transhepatic internal biliary drainage catheters.Surgery. 1984; 95: 603-607
- Hemobilia after liver biopsy. Early detection in a patient with mild hemophilia A.Arch Intern Med. 1980; 140: 839-840
- Intrahepatic aneurysm and hemobilia.Int Surg. 1976; 61: 135-138
- Ein Fall von Aneurysma Der Leberarterie.Klin Wochenschr. 1871; 8: 349-351
- Hemocholecyst following ruptured aneurysm of portal vein.Arch Surg. 1956; 72: 725-727
- Charles C. Thomas, Spring-field, Ill1972: 102 (Cited by Sandblom, P.) Hemobilia (biliary tract hemorrhage) history, pathology, diagnosis, treatment.
- Hemobilia associated with hemorrhagic cholecystitis in a patient with alcoholic cirrhosis.Conn Med. 1971; 35: 295-299
- Radiologic aspects of hemobilia.South Med J. 1981; 74: 829-836
- Angiographic diagnosis and treatment of hemobilia.Radiology. 1982; 144: 771-772
- Intrahepatic vascular lesions following nonsurgical percutaneous transhepatic bile duct intubation.Gastrointest Radiol. 1980; 5: 127-135
- Frequency of intrahepatic arteriovenous fistula as a sequela to percutaneous needle puncture of the liver.Gastroenterology. 1978; 74: 1204-1207
- Successful transcatheter embolic control of massive hematobilia secondary to liver biopsy.Am J Radiol. 1976; 127: 847-849
- Treatment of traumatic hemobilia with angiographic embolization.J Trauma. 1978; 18: 221-224
- Angiographic embolization as the definitive treatment of post-traumatic hemobilia.J Trauma. 1980; 20: 702-705
- Percutaneous angiographic embolization for hepatic arterial hemorrhage.Arch Surg. 1985; 120: 1241-1249
Accepted: November 17, 1988
☆Presented at the Fortieth Annual Meeting of the South-western Surgical Congress, Phoenix, Ariz., April 10–13, 1988.
© 1989 Published by Elsevier Inc.