Evaluation of selective hepatic angiography and embolization in patients with massive hemobilia.
BACKGROUND
Massive hemobilia is a rare but potentially life-threatening cause of upper gastrointestinal hemorrhage. Transarterial embolization is considered the first line of intervention to stop the bleeding for most causes of hemobilia. This study was conducted to evaluate selective hepatic angiography and embolization in the diagnosis and treatment of patients with massive hemobilia.


METHODS
The clinical data of 16 patients with massive hemobilia were analyzed retrospectively. These patients underwent emergency celiac and selective right or left hepatic artery angiography and treated by embolization using Gelfoam particles and/or coils.


RESULTS
Hepatic artery angiography revealed hepatic artery pseudoaneurysms in 6 patients, cystic artery pseudoaneurysms in 2, diffuse hemorrhage of hepatic artery branches in 5, and right hepatic artery-bile duct fistulae in 3. The patients were diagnosed rapidly by angiography and treated successfully by embolization of the hepatic artery branch proximal to the bleeding point, and hemorrhage was stopped immediately. Two patients were embolized the second time for rebleeding. Neither recurrence of bleeding nor serious complication was found during the follow-up for 3 months to 2 years. The other 2 patients whose hemorrhage failed to be controlled died several days later.


CONCLUSIONS
Being safe, reliable and minimally invasive, selective hepatic artery angiography and embolization are effective in the diagnosis and treatment of massive hemobilia.
Xu
Zeng-Bin
ZB
Department of Radiology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China. xuzengb@hotmail.com
Zhou
Xian-Yong
XY
Peng
Zhi-Yi
ZY
Xu
Shun-Liang
SL
Ruan
Ling-Xiang
LX
D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006431:Hemobilia / Q000000981:diagnostic imaging* / Q000628:therapy*; D006498:Hepatectomy / Q000379:methods; D006499:Hepatic Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015642:Radiology, Interventional; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome