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Hemobilia: An Uncommon But Notable Cause of Upper Gastrointestinal Bleeding

Cathcart, Scott MS*; Birk, John W. MD, FACG; Tadros, Michael MD; Schuster, Micheal MD§

Journal of Clinical Gastroenterology: October 2017 - Volume 51 - Issue 9 - p 796–804
doi: 10.1097/MCG.0000000000000876
Clinical Reviews

Goal and Background: A literature review to improve practitioners’ knowledge and performance concerning the epidemiology, diagnosis, and management of hemobilia.

Study: A search of Pubmed, Google Scholar, and Medline was conducted using the keyword hemobilia and relevant articles were reviewed and analyzed. The findings pertaining to hemobilia etiology, investigation, and management techniques were considered and organized by clinicians practiced in hemobilia.

Results: The majority of current hemobilia cases have an iatrogenic cause from either bile duct or liver manipulation. Blunt trauma is also a significant cause of hemobilia. The classic triad presentation of right upper quadrant pain, jaundice, and upper gastrointestinal bleeding is rarely seen. Computed tomography and magnetic resonance imaging are the preferred diagnostic modalities, and the preferred therapeutic management includes interventional radiology and endoscopic retrograde cholangiopancreatography. Surgery is rarely a therapeutic option.

Conclusions: With advances in computed tomography and magnetic resonance imaging technology, diagnosis with these less invasive investigations are the favored option. However, traditional catheter angiography is still the gold standard. The management of significant hemobilia is still centered on arterial embolization, but arterial and biliary stents have become accepted alternative therapies.

*Albany Medical Center, Albany Medical College

Departments of §Radiology

Gastroenterology & Hepatology, Albany Medical Center, Albany, NY

Division of Gastroenterology & Hepatology, Gastroenterology & Hepatology Fellowship Program, UConn School of Medicine, Farmington, CT

S.C.: research, main/corresponding author. J.W.B.: consultant and senior editor/author. M.T.: endoscopic images, consultant, and editor. M.S.: radiological images.

The authors declare that they have nothing to disclose.

Address correspondence to: Scott Cathcart, MS, Albany Medical Center, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208 (e-mail: cathcas@mail.amc.edu).

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.