Hemobilia
Disclosures
- updated 22 Aug 2023:
Nothing to disclose
Updates to Article Attributes
Body
was changed:
Haemobilia refers to the presence of blood in the biliary tree.
Clinical presentation
The classical clinicalQuincke triad, onlyis seen with haemobiliain ~50%the context of caseshepatic arterial aneurysms, and consists of:
Pathology
Aetiology
iatrogenic:
surgicalsurgical or percutaneous procedures (~67%)-
trauma (~5%)
associated with pseudoaneurysm formation from central liver trauma
may manifest several (2-4) weeks after the initial injury
-
vascular malformations (7%)
e.g. hepatic artery aneurysm or arteriovenous malformation
can cause massive haemobilia
malignancy (e.g.hepatocellular carcinoma- most common, gallbladder metastases)
abscess formation
gastrointestinal bleed due to gallstones
Radiographic features
Ultrasound
Ultrasound is often the first investigation and reveals echogenic material in the bile ducts and dilated gallbladder.
CT
high-attenuation clot within the bile ducts
-<p><strong>Haemobilia </strong>refers to the presence of blood in the <a href="/articles/biliary-tree-anatomy">biliary tree</a>.</p><h4>Clinical presentation</h4><p>The classical clinical triad, only seen in ~50% of cases, consists of:</p><ol>-<li>melaena (i.e. <a href="/articles/upper-gastrointestinal-bleeding">upper gastrointestinal bleeding</a>)</li>-<li><a href="/articles/jaundice">jaundice</a></li>-<li>abdominal pain</li>- +<p><strong>Haemobilia </strong>refers to the presence of blood in the <a href="/articles/biliary-tree-anatomy">biliary tree</a>.</p><h4>Clinical presentation</h4><p>The classical <a href="/articles/quincke-triad" title="Quincke triad">Quincke triad</a>, is seen with <a href="/articles/haemobilia" title="Haemobilia">haemobilia</a> in the context of <a href="/articles/hepatic-artery-aneurysm" title="Hepatic arterial aneurysms">hepatic arterial aneurysms</a>, and consists of:</p><ol>
- +<li><p><a href="/articles/melaena" title="melaena">melaena</a> (i.e. <a href="/articles/upper-gastrointestinal-bleeding">upper gastrointestinal bleeding</a>)</p></li>
- +<li><p><a href="/articles/jaundice">jaundice</a></p></li>
- +<li><p><a href="/articles/acute-abdominal-pain" title="Acute abdominal pain">abdominal pain</a></p></li>
-<li>iatrogenic: surgical or percutaneous procedures (~67%)</li>-<li>trauma (~5%)<ul>-<li>associated with <a href="/articles/false-aneurysm">pseudoaneurysm</a> formation from central <a href="/articles/liver-trauma">liver trauma</a>-</li>-<li>may manifest several (2-4) weeks after the initial injury</li>- +<li><p>iatrogenic: surgical or percutaneous procedures (~67%)</p></li>
- +<li>
- +<p>trauma (~5%)</p>
- +<ul>
- +<li><p>associated with <a href="/articles/false-aneurysm">pseudoaneurysm</a> formation from central <a href="/articles/liver-trauma">liver trauma</a></p></li>
- +<li><p>may manifest several (2-4) weeks after the initial injury</p></li>
-<li>vascular malformations (7%)<ul>-<li>e.g. hepatic artery aneurysm or arteriovenous malformation</li>-<li>can cause massive haemobilia</li>- +<li>
- +<p>vascular malformations (7%)</p>
- +<ul>
- +<li><p>e.g. hepatic artery aneurysm or arteriovenous malformation</p></li>
- +<li><p>can cause massive haemobilia</p></li>
-<li>malignancy (e.g. <a href="/articles/hepatocellular-carcinoma">hepatocellular carcinoma</a> - most common, <a title="Gallbladder metastases" href="/articles/gallbladder-metastases">gallbladder metastases</a>)</li>-<li>abscess formation</li>-<li>gastrointestinal bleed due to <a href="/articles/gallstones-1">gallstones</a>-</li>-</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Ultrasound is often the first investigation and reveals echogenic material in the bile ducts and dilated gallbladder.</p><h5>CT</h5><ul><li>high-attenuation clot within the bile ducts</li></ul>- +<li><p>malignancy (e.g. <a href="/articles/hepatocellular-carcinoma">hepatocellular carcinoma</a> - most common, <a href="/articles/gallbladder-metastases" title="Gallbladder metastases">gallbladder metastases</a>)</p></li>
- +<li><p>abscess formation</p></li>
- +<li><p>gastrointestinal bleed due to <a href="/articles/gallstones-1">gallstones</a></p></li>
- +</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Ultrasound is often the first investigation and reveals echogenic material in the bile ducts and dilated gallbladder.</p><h5>CT</h5><ul><li><p>high-attenuation clot within the bile ducts</p></li></ul>
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