Biliary Tract: Hemobilia & Pneumobilia

Hemobilia

Basics

  • Definition: Bleeding within Biliary Tract
  • Quinke’s Triad: Upper GI Bleed, Jaundice & RUQ Pain

Causes

  • Iatrogenic (Most Common)
    • Causes:
      • ERCP/Sphincterotomy
      • Liver Bx
      • TIPS
    • Results from an Arterobiliary Fistula Between CBD & Hepatic Artery (Pseudoaneurysm)
  • Trauma
  • Gallstones
  • Infection
  • Malignancy

Diagnosis

  • First Test: EGD (Rule Out Other Source)
  • Angiography Allows Dx & Tx
  • May Consider CTA

Treatment

  • Unstable: Angioembolization
    • Surgery if Fails
  • Stable:
    • Minor Bleeding: Conservative Management
    • Major Bleeding: Angioembolization vs Endoscopy
      • Endoscopic Options – Balloon Tamponade, Epinephrine Injection, Electrocoagulation or Hemoclip
      • Surgery if Fails

Bleeding from the Ampulla of Vater 1

Pneumobilia

Definition

  • Air within Biliary Tract

Causes

  • ERCP (Most Common)
  • Incompetent Sphincter of Oddi (Sphincterotomy, Gallstone, Scarring)
  • Biliary-Enteric Fistula (Gallstone Ileus)
  • Biliary-Enteric Anastomosis (Whipple, Choledochojejunostomy)
  • Infection (Rare)

Treatment

  • No Specific Treatment Required
  • Treat Any Underlying Pathology

Pneumobilia 2

References

  1. Alis H, Bozkurt MA, Oner OZ, Dolay K, Turhan AN, Uçar A, Inci E, Aygun E. Case report: acute pancreatitis caused by postcholecystectomic hemobilia. BMC Gastroenterol. 2010 Jul 7;10:75. (License: CC BY-2.0)
  2. Zeuge U, Fehr M, Meyenberger C, Sulz MC. Mind the sump! – diagnostic challenge of a rare complication of choledochoduodenostomy. Case Rep Gastroenterol. 2014 Nov 13;8(3):358-63.(License: CC BY-NC-3.0)