Hemobilia after percutaneous transhepatic biliary drainage: treatment with transcatheter embolotherapy.

Thirteen of 333 patients who underwent percutaneous biliary drainage (PBD) developed severe hemobilia. Hepatic arteriography successfully demonstrated the source of hemorrhage in all 13 patients. Lesions included hepatic artery pseudoaneurysm in nine, hepatic artery-bile duct fistulas in four, and a hepatic artery-portal vein fistula in one patient. Hemobilia occurred from 1 day to 1.8 years (mean, 100 days) following catheter placement. Embolization agents used included Hilal embolization microcoils, occluding spring emboli, cyanoacrylate, detachable balloons, and gelatin sponge pledgets. A single agent was used in eight cases (62%), multiple agents were used in four cases (31%), and in one case (7%), spontaneous thrombosis of the pseudoaneurysm occurred during catheter manipulation. In five patients, the source of the hemorrhage could only be demonstrated following removal of the biliary catheter(s) over guide wire(s). Initial embolization was successful in stopping hemobilia in 12 patients. One patient required repeat embolization after 4 months. Postembolization complications included hepatic abscess formation in two patients and a sterile hepatic infarct in one patient. This series indicates that transcatheter embolotherapy is an effective method for the treatment for severe hemobilia.