Selective surgical indications for iatrogenic hemobilia.

BACKGROUND: This study was undertaken to assess the place for surgery in patients with iatrogenic hemobilia.
METHODS: Nineteen patients were treated for hemobilia caused by percutaneous liver biopsy (n = 11), percutaneous transhepatic cholangiography (PTC, n = 5), or percutaneous biliary drainage (PBD, n = 3). Selective embolization was attempted in all patients who bled after percutaneous liver biopsy or PTC but one, whereas irrigation via the external catheter was tried first in patients bleeding after PBD.
RESULTS: Selective embolization was successful in 13 cases (87%) of 15. Technical impossibility of selective embolization (n = 2) and absence of recognizable vascular lesion (n = 1) were the reasons for surgery in three actively bleeding patients. Indications for delayed surgery included hemocholecystitis (n = 3) and inadvertent embolization of the gallbladder (n = 1). Biliary decompression was only required after PTC and was achieved by endoscopic sphincterotomy (n = 3), percutaneous transtumoral intubation (n = 1), or surgery (n = 1) after failure of percutaneous biliary dilation. After PBD, repeat irrigation and tube replacement were used to stop the bleeding and to decompress the biliary tract without embolization or surgery. None of the 19 patients died, and none experienced recurrent bleeding.
CONCLUSION: Surgical indications for iatrogenic hemobilia are limited and include failure or complication of arterial embolization, hemocholecystitis, and failed attempt at endoscopic or percutaneous biliary decompression in case of obstructive jaundice.