title: A severe case of hemobilia and biliary fistula following an open urgent cholecystectomy.
abstract: 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.
authors.affiliation: General Surgery and Emergency Clinic, University of Perugia S, Maria Hospital, Terni, Italy. e_napolitano@libero.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Napolitano
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Spizzirri
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cattorini
authors.forename: Francesco
authors.initials: F
authors.lastname: La Mura
authors.forename: Eriberto
authors.initials: E
authors.lastname: Farinella
authors.forename: Umberto
authors.initials: U
authors.lastname: Morelli
authors.forename: Carla
authors.initials: C
authors.lastname: Migliaccio
authors.forename: Pamela
authors.initials: P
authors.lastname: Del Monaco
authors.forename: Stefano
authors.initials: S
authors.lastname: Trastulli
authors.forename: Micol Sole
authors.initials: MS
authors.lastname: Di Patrizi
authors.forename: Diego
authors.initials: D
authors.lastname: Milani
authors.forename: Francesco
authors.initials: F
authors.lastname: Sciannameo