Haemobilia is a medical condition of bleeding into the biliary tree. Haemobilia occurs when there is a fistula between a vessel of the splanchnic circulation and the intrahepaticorextrahepatic biliary system. It can present as acute upper gastrointestinal (UGI) bleeding. It should be considered in upper abdominal pain presenting with UGI bleeding especially when there is a history of liver injury or instrumentation.[citation needed]
First recorded in 1654 by Francis Glisson, a Cambridge professor.[1]
It can be immediately life-threatening in major bleeding. However, in minor haemobilia, patient is haemodynamically stable despite significant blood loss being apparent.[3]
Combination of EGD, CT scan and angiography depending on clinical situation, bearing in mind that haemobilia may present many days after injury. Cholangiography is performed if there is a percutaneous access or if ERCP is undertaken.[citation needed]
Most bleeding from instrumentation are minor and would settle spontaneously.[citation needed]
When indicated, management is directed towards stopping bleeding and relieving obstruction if present, which is achieved either by surgical ligation of hepatic artery or by endovascularembolisation. Endovasculartrans-arterial embolisation (TAE) is preferred initially because of high success rate and less complication. TAE involves the selective catheterization of a hepatic artery followed by embolic occlusion. Surgery is indicated when TAE has failed or sepsis present in biliary tree or drainage has failed.[citation needed]
^Francis Glisson (1993). From Anatomia hepatis (the Anatomy of the liver), 1654 (Cambridge Wellcome texts and documents). Cambridge: Wellcome Unit for the History of Medicine. ISBN0-9516693-3-8. OCLC33046433.
^Quincke, H. (1871). "Ein Fall von Aneurysma der Leberarterie". Berl Klin Wochenschr. 30: 349–352.
