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Haemobilia (bleeding in the biliary tree) occurs when conditions produce an abnormal communication between blood vessels and bile ducts.[1] It is rare and diagnosis requires a degree of diagnostic suspicion. Haemobilia may be major, causing life-threatening haemorrhage, or minor.[2] It can present many weeks after the initial injury.[3] Bleeding can lead to biliary obstruction.

The most common cause is liver biopsy. Other more common causes include trauma, malignancy, arterio-biliary or arterio-portal fistula and pseudoaneurysm of the hepatic arteries.[1] Haemobilia may be due to:

There is concern that the increased use of invasive procedures and the trend toward conservative management of major trauma has resulted in an increased incidence of haemobilia. However, the Southampton review concluded that there was no evidence that the conservative management of accidental liver trauma increases the risk of haemobilia.[2]

Although rare, haemobilia should be considered in upper abdominal pain associated with upper gastrointestinal bleeding, especially when there is a history of liver injury or instrumentation.
  • Blood tests:
  • Endoscopy:
    • Endoscopy is diagnostic in only 12% of cases, by visualising blood draining from the papilla of Vater.[3]
  • Imaging:
    • CT or MRI scanning may show evidence of a clot. CT may be useful in identifying haemobilia as a complication of blunt liver trauma.[11]
    • MRI with cholangiopancreatographic sequences and T1- and T2-weighted MRI may help to detect haemobilia.[12]
    • Diagnosis of haemobilia is usually achieved by angiography.[2]
    • Treatment is often possible at the same time as angiography by embolisation of the lesion.[2, 4]
  • This depends on the underlying cause.
  • Assessment and management of Airway, Breathing and Circulation (ABC) should take place in the first instance.
  • Conservative management may be all that is needed in minor bleeding.[2]
  • In iatrogenic cases, conservative management is often adequate, as bleeding can stop spontaneously.
  • Transcatheter hepatic artery embolisation is commonly used in the management of haemobilia.[4, 5, 10]
  • Surgical exploration may be required if embolisation fails. This can allow ligation of the bleeding point.
  • The mortality rate in the Southampton review discussed under 'Aetiology', above, was 5%.[2]

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Current Version:
Dr Colin Tidy
Peer Reviewer:
Dr Adrian Bonsall
Document ID:
2217 (v22)
Last Checked:
14 December 2011
Next Review:
12 December 2016

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