title: [Therapeutic approach to hemobilia].
abstract: OBJECTIVE
  Hemobilia, defined as hemorrhage arising from pathological changes in the biliary tract, represents a rare entity. In a retrospective study the presentation, diagnosis, and management of hemobilia were investigated.
  
  
  METHODS
  Since January 1991 six patients suffering from severe hemobilia presented to our department. Jaundice, right upper quadrant abdominal pain, hematemesis and melaena were the most frequent symptoms leading to admission. Hemobilia originated from iatrogenic injury following percutaneous liver biopsy and endoscopic removal of common bile duct stones, and malignant hepatic or biliary tumors. Duodenoscopy revealed bleeding from the papilla in all patients. Diagnosis was confirmed by ERCP in all patients and angiography in 5 of 6 patients.
  
  
  RESULTS
  Angiographic occlusion of an arterial lesion with coils was successfully achieved in one patient. One patient was treated conservatively. In 3 patients liver resections were performed to control bleeding and the underlying tumorous pathology. In another patient, operative ligation of the supplying artery had to be performed. Within a minimum follow-up of six months none of the six patients showed recurrence of hemobilia.
  
  
  CONCLUSIONS
  Considering the impact of etiologic, diagnostic and therapeutic aspects in treatment of hemobilia we suggest an algorithm for a rational approach to hemobilia. Angiographic occlusion may control the bleeding and improve the patient's general condition. Definitive surgical treatment of hemobilia is safe and effective.
authors.affiliation: Abteilung für Allgemeinchirurgie, Universität Hamburg.
authors.forename: J R
authors.initials: JR
authors.lastname: Izbicki
authors.forename: C
authors.initials: C
authors.lastname: Bloechle
authors.forename: R
authors.initials: R
authors.lastname: Kühn
authors.forename: W T
authors.initials: WT
authors.lastname: Knoefel
authors.forename: X
authors.initials: X
authors.lastname: Rogiers
authors.forename: C E
authors.initials: CE
authors.lastname: Broelsch
mesh_terms: D000368:Aged; D000792:Angiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003937:Diagnosis, Differential; D004384:Duodenoscopy; D005260:Female; D006431:Hemobilia / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
vernacular_title: Therapiekonzept der Hämobilie.