Korean J Gastroenterol.  2012 Apr;59(4):296-302. 10.4166/kjg.2012.59.4.296.

Etiology, Clinical Features, and Endoscopic Management of Hemobilia: A Retrospective Analysis of 37 Cases

• Kim KH
• Kim TN

• KMID: 1364833
• DOI: http://doi.org/10.4166/kjg.2012.59.4.296

Abstract

BACKGROUND/AIMS
Hemobilia is a rare cause of upper gastrointestinal bleeding. Endoscopic retrograde cholangiopancreaticography (ERCP) is considered to be an excellent diagnostic and treatment modality. Thirty-seven cases of hemobilia with different underlying pathologies were analyzed to illustrate clinical features and to evaluate the role of endoscopic management.
METHODS
A total of 37 patients (26 men and 11 women; mean age, 66.2+/-15.3 years) who were confirmed to have hemobilia by ERCP in a single center from 2000 to 2010 were reviewed retrospectively. Patients with iatrogenic causes of hemobilia were excluded in this study.
RESULTS
The causes of hemobilia were hepatocellular carcinoma in 14, bile duct and gallbladder malignancies in 12, common bile duct stones with cholangitis in 4, acute cholecystitis in 4, and pancreatic cancer in 2 patients. The clinical features of hemobilia were jaundice (89.2%), abdominal pain (78.4%), and melena (13.5%). The cholangiographic findings of hemobilia were amorphous filling defects in 15, tubular filling defects in 6, and cast-like filling defects in 6 patients. Endoscopic management included endoscopic nasobiliary drainage in 26 patients and endoscopic retrograde biliary drainage in 7 patients. Biliary obstruction caused by hemobilia was successfully treated with endoscopic biliary drainages in most cases.
CONCLUSIONS
The most common non-iatrogenic causes of hemobilia were hepatobiliary malignancies, and the majority of patients presented with jaundice and abdominal pain. Endoscopic biliary drainage is recommended as the initial management to control biliary obstruction.

Keyword

Hemobilia; Endoscopic retrograde cholangiopancreaticography; Endoscopic nasobiliary drainage; Biliary drainage

MeSH Terms

Abdominal Pain/etiology
Adult
Aged
Aged, 80 and over
Bile Duct Neoplasms/complications
Carcinoma, Hepatocellular/complications
Cholangiopancreatography, Endoscopic Retrograde
Cholecystectomy
Cholecystitis/complications
Drainage
Female
Gallstones/complications
Hemobilia/*diagnosis/etiology/therapy
Humans
Jaundice/etiology
Liver Neoplasms/complications
Male
Middle Aged
Pancreatic Neoplasms/complications
Retrospective Studies

Figure

• 

  Fig. 1 Endoscopic retrograde cholangiographic findings of hemobilia. (A) In a 59-year-old male with hepatocellular carcinoma, cholangiogram showed a large, cast-like filling defect in the dilated common bile duct. (B) In a 68-year-old male with hepatocellular carcinoma, cholangiogram showed a longitudinal, tubular filling defect in the common bile duct and the right main intrahepatic duct. (C) In a 78-year-old male with common bile duct cancer, cholangiogram showed ill-defined, amorphous filling defects in the proximal common bile duct and bifurcation of the bile duct. (D, E) In a 79-year-old male with acute suppurative cholangitis, ERCP demonstrated that large amounts of blood admixed with pustulous bile was gushing out after endoscopic retrograde biliary drainage, but, cholangiogram showed no demonstrable filling defect in the dilated common bile duct. (F) In a 75-year-old male with gallbladder cancer, cholangiogram showed amorphous filling defects within the distended gallbladder with no demonstrable filling defect in the common bile duct.

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