Haemobilia embolization

Fig. 7.1a,b. Coeliac angiography in a patient with life threatening haemobilia 24 h post cholecystectomy revealed a large hepatic pseudoaneurysm (a) treated successfully by proximal and distal coil embolization (b)... 

Haemobilia requires treatment as spontaneous resolution is exceedingly rare and the mortality from ruptured pseudoaneurysms is in excess of 90%. Technically endovascular management is relatively simple and involves the proximal and distal embolization, with tightly packed steel coils, of the hepatic... 

The results of embolization for haemobilia are reported as being 95%-100% effective [3] even on an intention to treat basis and it should be the treatment of first choice. 

The complications of embolization for pancreatitis associated visceral pseudoaneurysms are the same as for the treatment of haemobilia. In addition and as mentioned the repeated use of bovine or human thrombin can lead to anaphylaxis and though rare, autologous thrombin is recommended. 

Aneurysms and pseudoaneurysms causing haemobilia or associated with pancreatitis are potentially fatal. Imaging, particularly CECT, is vital to their diagnosis. Conservative therapy is a poor option and treatment, which was formally via open surgery, is now best carried out by angiography and percutaneous coil embolization in haemobilia and for Type la and b pancreatitis associated pseudoaneurysms. Percutaneous CT guided thrombin therapy is indicated for Type 2 aneurysms. 

Nicholson A, Travis S, Ettles DF et al (1999) Hepatic artery angiography and embolization for haemobilia following laparoscopic cholecystectomy. CVIR 22 42-47... 

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