title: Transcatheter arterial embolization for iatrogenic hemobilia is a safe and effective procedure:  case series and review of the literature.
abstract: OBJECTIVE
  Hemobilia is an uncommon cause of gastrointestinal bleeding. The etiology is diverse, but most often, it is iatrogenic. The present study aims to reassess the clinical picture and the treatment of choice.
  
  
  METHODS
  We describe a case series from a single center of patients who presented with nontraumatic iatrogenic hemobilia.
  
  
  RESULTS
  Over a period of 8 years, hemobilia occurred in 12 patients: following liver biopsy in six patients and after endoscopic biliary interventions in four patients, with a respective prevalence of 0.1 and 0.04%. The clinical presentation was characterized by an upper gastrointestinal bleeding (n=11) and/or biochemical signs of sudden biliary obstruction (n=9). The onset of the symptoms occurred after a median of 6 days (range: 1-23). Ultrasound and computed tomography scan missed the diagnosis in, respectively, 4/5 and 2/5 of patients. On arteriography, pseudoaneurysm (6/12) was the most common finding. Transcatheter arterial embolization controlled the bleeding in all cases (12/12) without major complications.
  
  
  CONCLUSIONS
  The delay between the intervention and the clinical presentation and the fact that imaging studies may fail to diagnose hemobilia may mislead the physician. Transcatheter arterial embolization is the treatment of choice for hemobilia. It has proven to be effective and safe and it offers a long-term definitive cure.
authors.affiliation: Department of Liver and Biliopancreatic Diseases bInterventional Radiology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, Leuven, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Marynissen
authors.forename: Geert
authors.initials: G
authors.lastname: Maleux
authors.forename: Sam
authors.initials: S
authors.lastname: Heye
authors.forename: Johan
authors.initials: J
authors.lastname: Vaninbroukx
authors.forename: Wim
authors.initials: W
authors.lastname: Laleman
authors.forename: David
authors.initials: D
authors.lastname: Cassiman
authors.forename: Chris
authors.initials: C
authors.lastname: Verslype
authors.forename: Schalk
authors.initials: S
authors.lastname: Van der Merwe
authors.forename: Werner
authors.initials: W
authors.lastname: Van Steenbergen
authors.forename: Frederik
authors.initials: F
authors.lastname: Nevens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D001158:Arteries; D057785:Catheters; D002648:Child; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006431:Hemobilia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016896:Treatment Outcome; D055815:Young Adult