Diagnosis and management of hemobilia

Hemobilia is an uncommon but nonetheless important cause of gastrointestinal hemorrhage in which the radiologist plays an important role in both diagnosis and treatment. Hemobilia should be considered when a patients present with either upper- or lower-gastrointestinal bleeding following abdominal trauma, biliary surgery, needle puncture of the liver, or percutaneous transhepatic biliary drainage. Selective hepatic arteriography often establishes the diagnosis and demonstrates the site of hemorrhage, which may appear as a pseudoaneurysm, arterioportal fistula, or direct extravasation into the biliary tract. With biliary drainage, tract may be useful for imaging of the causative lesion. Selective transcatheter vascular occlusion is a rapid and safe method of achieving hemostasis and should be the treatment of choice. Direct occlusion of the underlying lesion or its small feeding branch is the best mode of occlusive treatment. Central occlusion of a large feeding branch or larger hepatic artery is an effective and safe alternative. Nonselective peripheral liver embolization must be avoided. With biliary drainage, the lesion causing hemobilia may be occluded directed from the biliary tract.