A severe case of hemobilia and biliary fistula following an open urgent cholecystectomy.
BACKGROUND
Cholecystectomy has been the treatment of choice for symptomatic gallstones, but remains the greatest source of post-operative biliary injuries. Laparoscopic approach has been recently preferred because of short hospitalisation and low morbidity but has an higher incidence of biliary leakages and bile duct injuries than open one due to a technical error or misinterpretation of the anatomy. Even open cholecystectomy presents a small number of complications especially if it was performed in urgency. Hemobilia is one of the most common cause of upper gastrointestinal bleeding from the biliary ducts into the gastrointestinal tract due to trauma, advent of invasive procedures such as percutaneous liver biopsy, transhepatic cholangiography, and biliary drainage.


METHODS
We report here a case of massive hemobilia in a 60-year-old man who underwent an urgent open cholecystectomy and a subsequent placement of a transhepatic biliary drainage.


CONCLUSIONS
The management of these complications enclose endoscopic, percutaneous and surgical therapies. After a diagnosis of biliary fistula, it's most important to assess the adequacy of bile drainage to determine a controlled fistula and to avoid bile collection and peritonitis. Transarterial embolization is the first line of intervention to stop hemobilia while surgical intervention should be considered if embolization fails or is contraindicated.
Napolitano
Vincenzo
V
General Surgery and Emergency Clinic, University of Perugia S, Maria Hospital, Terni, Italy. e_napolitano@libero.it.
Cirocchi
Roberto
R
Spizzirri
Alessandro
A
Cattorini
Lorenzo
L
La Mura
Francesco
F
Farinella
Eriberto
E
Morelli
Umberto
U
Migliaccio
Carla
C
Del Monaco
Pamela
P
Trastulli
Stefano
S
Di Patrizi
Micol Sole
MS
Milani
Diego
D
Sciannameo
Francesco
F