title: Hemobilia: presentation, diagnosis, and management.
abstract: OBJECTIVE
  Hemobilia is defined as hemorrhage into the biliary tract. To define a rational approach toward this rare entity, we performed a retrospective study on the presentation, diagnosis, and management of hemobilia.
  
  
  METHODS
  During the past 3 yr, eight patients suffering from severe hemobilia presented to our departments. Jaundice, right-sided upper abdominal pain, and hematemesis were the most frequent symptoms. Hemobilia originated from iatrogenic injury in three patients, malignant hepatic or biliary tumors in three, parasitic infestation (ascariasis) in one, and coagulopathy due to end-stage liver cirrhosis in one. Duodenoscopy revealed bleeding from the papilla in all patients. Diagnosis was confirmed by endoscopic retrograde cholangiopancreatography and angiography in seven patients.
  
  
  RESULTS
  In three patients, major liver resections were performed that definitively controlled the bleeding and the underlying tumor. Angiographic occlusion of an arterial lesion was successfully achieved in two patients. In two patients, operative ligation of the supplying artery was required. The patient suffering from end-stage liver disease was treated by substitution of coagulation factors but died due to progressive metabolic liver failure.
  
  
  CONCLUSIONS
  Angiographic occlusion is recommended as initial treatment to control hemobilia and to render the patient stable in preparation for elective and definitive surgery. Surgery becomes necessary when nonoperative attempts to stop the bleeding fail and is required for tumors and parasitic disease.
authors.affiliation: Department of Surgery, University of Hamburg, Federal Republic of Germany.
authors.forename: C
authors.initials: C
authors.lastname: Bloechle
authors.forename: J R
authors.initials: JR
authors.lastname: Izbicki
authors.forename: M Y
authors.initials: MY
authors.lastname: Rashed
authors.forename: T
authors.initials: T
authors.lastname: el-Sefi
authors.forename: S B
authors.initials: SB
authors.lastname: Hosch
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: D002760:Cholangiopancreatography, Endoscopic Retrograde; D004621:Embolization, Therapeutic; D005260:Female; D006431:Hemobilia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D006498:Hepatectomy; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008026:Ligation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies