-Severe hemobilia after percutaneous transhepatic biliary drainage. Successful treatment by arterial catheter embolization-.
We report on an 44-year-old man with Billroth-I-reoperation and transformation into Roux-Y-anastomosis, which was performed because of ulcer-relapse. The postoperative course was complicated by obstructive jaundice and cholangitis. Ultrasound and computed tomography could not clarify the cause. The subsequently performed percutaneous transhepatic cholangiography showed several small concrements in the biliary tract. For decompression of the dilated bile ducts percutaneous transhepatic biliary drainage was applied. Following that the patient developed recurrent episodes of hemobilia, which made the transfusion of altogether 17 units of blood necessary. Angiography clarified the bleeding source showing leakage of the right hepatic artery. By means of repeated selective transcatheter embolization definite hemostasis was achieved. Transcatheter embolotherapy is recommended as initial treatment to control serious iatrogenic hemobilia.
Neef
B
B
Medizinische Klinik, Krankenhaus Bad Cannstatt, Stuttgart.
Sinn
I
I
Walter
E
E
Stumpf
E
E
Kieninger
G
G
von Gaisberg
U
U
D000328:Adult; D000713:Anastomosis, Roux-en-Y; D000792:Angiography; D002758:Cholangiography; D001651:Cholestasis, Extrahepatic / Q000000981:diagnostic imaging / Q000628:therapy*; D004322:Drainage / Q000295:instrumentation*; D004381:Duodenal Ulcer / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D042882:Gallstones / Q000000981:diagnostic imaging / Q000628:therapy; D006431:Hemobilia / Q000000981:diagnostic imaging / Q000628:therapy*; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000293:injuries; D006801:Humans; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000601:surgery*; D012086:Reoperation
Schwere Hämobilie nach perkutan-transhepatischer biliärer Drainage. Erfolgreiche Behandlung durch arterielle Katheterembolisation.