Treatment of hemobilia with selective hepatic artery embolization.
OBJECTIVE
To evaluate retrospectively the results of selective transcatheter embolization in the treatment of hemobilia.


METHODS
Twelve patients with hemobilia (mean age, 43 years) underwent embolotherapy. Causes of hepatic vascular injury were iatrogenic trauma, blunt external trauma, septic emboli, and lupus vasculitis. A 5-F cobra catheter or a 5-F non-tapered Simmons shaped catheter passed over a hydrophilic guide wire, or a Tracker 18 catheter forming a coaxial system was used. Embolic agents included gelatin sponge or polyvinyl alcohol fragments used alone or with coils.


RESULTS
Hepatic artery pseudoaneurysms were found in 10 patients, ruptured hepatic artery aneurysm was found in one, and arterioportal fistula was found in two (with pseudoaneurysm in one). Bleeding was immediately controlled in 11 of 12 patients after embolization; one patient rebled and underwent surgery. Two patients underwent repeat embolization (2 weeks and 2 months later). Two patients died, one of biliary sepsis and liver insufficiency 24 hours after embolization and the other of gangrenous cholecystitis.


CONCLUSIONS
Transcatheter embolization is an effective treatment of hemobilia. It allows control of bleeding and identification of the origin of the hemorrhage.
Department of Diagnostic Radiology, Ciutat Sanitària i Universitària de Bellvitge, Barcelona, Spain.
F
F
Hidalgo
J A
JA
Narváez
M
M
Reñé
J
J
Domínguez
C
C
Sancho
X
X
Montanyà
D000293:Adolescent; D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000628:therapy; D004621:Embolization, Therapeutic; D005260:Female; D006431:Hemobilia / Q000209:etiology / Q000628:therapy*; D006499:Hepatic Artery; D006801:Humans; D008099:Liver / Q000293:injuries; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies