Hemobilia: Etiology, diagnosis, and treatment

Rani Berry, James Han, Ani A. Kardashian, Nicholas F. LaRusso, James H. Tabibian

Research output: Contribution to journalReview article

5 Scopus citations

Abstract

Hemobilia refers to bleeding from and/or into the biliary tract and is an uncommon but important cause of gastrointestinal hemorrhage. Reports of hemobilia date back to the 1600s, but due to its relative rarity and challenges in diagnosis, only in recent decades has hemobilia been more critically studied. The majority of cases of hemobilia are iatrogenic and caused by invasive procedures involving the liver, pancreas, bile ducts and/or the hepatopancreatobiliary vasculature, with trauma and malignancy representing the two other leading causes. A classic triad of right upper quadrant pain, jaundice, and overt upper gastrointestinal bleeding has been described (i.e. Quincke's triad), but this is present in only 25%–30% of patients with hemobilia. Therefore, prompt diagnosis depends critically on having a high index of suspicion, which may be based on a patient's clinical presentation and having recently undergone (peri-) biliary instrumentation or other predisposing factors. The treatment of hemobilia depends on its severity and suspected source and ranges from supportive care to advanced endoscopic, interventional radiologic, or surgical intervention. Here we provide a clinical overview and update regarding the etiology, diagnosis, and treatment of hemobilia geared for specialists and subspecialists alike.

Original languageEnglish (US)
Pages (from-to)200-208
Number of pages9
JournalLiver Research
Volume2
Issue number4
DOIs
StatePublished - Dec 2018

Keywords

  • Diagnosis
  • Etiology
  • Hemobilia
  • Hepatopancreatobiliary interventions
  • Imaging
  • Upper gastrointestinal hemmorhage

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

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  • Cite this

    Berry, R., Han, J., Kardashian, A. A., LaRusso, N. F., & Tabibian, J. H. (2018). Hemobilia: Etiology, diagnosis, and treatment. Liver Research, 2(4), 200-208. https://doi.org/10.1016/j.livres.2018.09.007