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Minimally invasive image-guided interventional management of Haemobilia
 
TV Prasad1, AK Gupta1, P Garg2, S Pal3, S Gamanagatti1
Department of Radiodiagnosis1,
Gastroenterology2 and
Gastrointestinal Surgery3
All India Institute of Medical Sciences,
New Delhi-110029


Corresponding Author
: Dr Shivanand Gamanagatti
Email: shiv223@gmail.com


Abstract

Hemobilia is a well known cause for upper gastrointestinal (UGI) bleed seen commonly in setting of iatrogenic or accidental trauma and various inflammatory and neoplastic conditions. Patients present with UGI bleed and symptoms of associated biliary obstruction. Management options in intractable cases are surgery and endovascular embolisation. We report a series of eighteen patients presented with severe hemobilia from January 2010 to October 2014, who were managed by endovascular approach in our department. Etiology in these patients were trauma (n=3), liver biopsy (n=3), surgery (n=3), percutaneous procedures (n=2), inflammatory (n-3), neoplasm (n=1) and the rest were idiopathic. Angiography revealed pseudoaneurysms of hepatic artery (n=5), splenic artery (n=1) and gastroduodenal artery (n=1) and arteriobiliary fistula (n=1). Embolising agents used were detachable coils (n=10) and glue (n=8). All patients had technical and clinical success with minor non-consequential complications. Our findings show that endovascular embolisation is a simple, safe, accurate and effective treatment in patients with severe hemobilia. It is a viable alternative to major and potentially morbid surgeries.