Hemobilia is a rare but significant source of gastrointestinal hemorrhage and relates to bleeding into or from the biliary tract. Hemobilia is rare and hard to diagnose. Surgery or other invasive procedures on the liver, pancreas, bile ducts, or hepatopancreatobiliary vasculature causes iatrogenic hemobilia. Iatrogenic hemobilia accounts for the majority of cases of hemobilia. Other prominent causes of hemobilia include trauma and cancer.
Hemobilia is characterized by abrupt upper abdominal pain, and upper gastrointestinal bleeding and particularly in patients with a record of liver instrumentation or injury. Among abdominal organs, the liver is the most vulnerable, and roughly 2% of individuals with severe liver damage develop hemobilia.
Hemobilia can be treated with advanced endoscopic, surgical techniques, or interventional radiologic, as well as supportive care, depending on its severity and presumed source. Localizing the bleeding location and stopping the bleeding are priorities in hemobilia care.
Anemia symptoms are commonly found in patients who have experienced an acute hemorrhage. When a patient has any record of hepatobiliary manipulation or trauma, a fast evaluation for clinical hemobilia should be performed whenever there is bleeding from the gastrointestinal tract (either the upper or lower portion), as well as blood in drains that have been inserted percutaneously or surgically. In cases of persistent infection or foreign bodies, such as post-traumatic abscesses that need to be drained or extended biliary drainage for recurring infections or tumor blockage, the time between surgical intervention and bleeding may be prolonged.
Melena, stomach discomfort, hematemesis, and jaundice are some of the hemobilia’s presenting symptoms. Symptoms of iron deficiency anemia can include slowly bleeding lesions. The Quincke triad is a clinical sign that points to biliary tract bleeding as the source of a patient’s upper GI bleeding, jaundice, and oblique upper abdominal pain.
Extremely deadly consequences may result if the patient experiences extensive bleeding. When there is only little hemorrhage, the patient is frequently hemodynamically stable even though there has been significant blood loss.
Haemobilia is most commonly caused by trauma (either accidental or iatrogenic, as in the case of cholecystectomy), instrumentation (particularly after ERCP), gallstone, inflammatory disorders such as ascariasis and PAN, vascular malformation, malignancies, coagulopathy, and liver biopsies.
As indicated, posttraumatic hemobilia causes more than half of all cases. Hemobilia can also result from violent crimes and auto accidents that inflict blunt or piercing injuries to the liver. Hemobilia is a condition that emerges from the management of hepato-biliary illnesses using intubation methods and percutaneous biopsy.
The clinical evaluation of patients in which neither an iatrogenic nor a non-iatrogenic traumatic cause is apparent should evaluate intrahepatic or biliary malignancy (such as hepatocellular carcinoma, cholangiocarcinoma, and secondary hepatic metastases).
It is essential to rule out other potential causes of upper GI bleeding before conclusively diagnosing hemobilia. Multiple diagnostic procedures, including computed tomography (CT) scanning, angiography, and esophagogastroduodenoscopy (EGD), are performed. Investigations are determined by a patient’s clinical condition.
If hemobilia is suspected clinically, the first step in treating the patient is to restore normal blood clotting and do other life-sustaining measures. Minor hemobilia bleeding caused by instrumentation resolves spontaneously in the majority of individuals without therapy.
The underlying aetiology of the hemobilia determines the therapeutic strategy. When considering potential treatment options like angiography or surgery, it is important to first get a thorough understanding of the patient’s unique anatomy. It is more likely that photocoagulation or electrocoagulation utilizing biliary endoscopy will be successful if the biliary tree is reachable by a percutaneous tube route. When all other tests come up negative, a surgical examination is often the last resort for diagnosis and treatment.
When there is significant bleeding, the goal of treatment is to stop the bleeding and remove any obstructions so that the bile flow can resume. Surgical intervention, photocoagulation, or electrocoagulation, as well as angiography combined with embolization, are some of the methods that can be utilized to accomplish this goal. The clinician will need to weigh the benefits and drawbacks of endoscopic embolization versus surgical closure of the hepatic artery before making a decision.