[Interventional treatment of hemobilia].
OBJECTIVE
Aim of the study was to assess the use of embolisation in cases of iatrogenic haemobilia.


METHODS
In 18 patients with severe haemobilia after percutaneous biliary system drainage or stent implantation, an embolisation with minicoils (17 x) or gelfoam particles, was performed. To achieve a sufficient vascular obstruction, Histoacryl (4 x) or Ethibloc (1 x) were additionally used in five cases. A transarterial approach was used in 17 cases. In one patient, an approach through the biliary system was possible.


RESULTS
In all cases, the bleeding source was identified (5 false aneurysms, three biliary leaks, 9 irregularities at the junction of the artery and drainage catheter, 1 multiple collaterals at the proximal end of the stent). In 17 out of 18 cases, haemorrhage ceased definitely. In one case of a patient with pancreas carcinoma and obstruction of the portal vein as well as a simultaneous high grade stenosis of the hepatic artery propria, it was only possible to embolise small collaterals to avoid liver necrosis. This resulted in an incomplete bleeding of control. An infected haematoma was the only complication. It was treated by drainage over 10 days. During an observation period ranging approximately 7.6 months, 10 of the patients died due to their basic illness.


CONCLUSIONS
Embolisation is an effective procedure in the treatment of haemobilia, with a low complication rate.
Sokiranski
R
R
Radiologische Klinik und Poliklinik der Universitätsklinik Ulm.
Rilinger
N
N
Brado
M
M
Huppert
P
P
Vogel
J
J
Brambs
H J
HJ
Görich
J
J
D000368:Aged; D000792:Angiography; D003973:Diatrizoate / Q000008:administration & dosage; D004338:Drug Combinations; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D004659:Enbucrilate / Q000008:administration & dosage; D005069:Evaluation Studies as Topic; D005227:Fatty Acids / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage; D006431:Hemobilia / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006490:Hemostatics / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D011409:Propylene Glycols / Q000008:administration & dosage; D012597:Sclerosing Solutions; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D015028:Zein / Q000008:administration & dosage
D004338:Drug Combinations; D005227:Fatty Acids; D006490:Hemostatics; D011409:Propylene Glycols; D012597:Sclerosing Solutions; D003973:Diatrizoate; D015028:Zein; C020481:alcoholic prolamine solution; D004659:Enbucrilate