Hemobilia: A Narrative Review of Current Diagnostic Techniques and Emerging Management Strategies

Abstract

Hemobilia is a relatively uncommon but important cause of gastrointestinal bleeding. It occurs due to abnormal communications between the biliary system and surrounding vasculature, often caused by surgical interventions, trauma, infections, or malignancies. The rise of advanced hepato-pancreato-biliary techniques, including radiofrequency ablation and transjugular intrahepatic portosystemic shunt (TIPS) placement, necessitates careful evaluation for the potential presence of hemobilia during the post-procedural period of these patients. Hemobilia can be difficult to diagnose, as common symptoms like jaundice, abdominal pain, and gastrointestinal bleeding are not always present together. Imaging techniques such as Doppler ultrasound, contrast-enhanced computed tomography (CT), and angiography are critical for identifying the source of bleeding. Treatment typically focuses on achieving hemostasis and ensuring proper bile flow, with options including endoscopic techniques, angiography with transcatheter arterial embolization, and, in severe cases, surgical intervention. This review highlights recent advances in diagnostic and therapeutic approaches, emphasizing the need for early recognition and tailored interventions to improve patient outcomes.

Keywords: biliary tract hemorrhage; endoscopic management; gastrointestinal tract bleeding; hemobilia; hepatic vascular injury; hepato-biliary; hepato-pancreato-biliary surgery; iatrogenic lesion; quincke's triad; transcatheter arterial embolization.

Figure 1. Causes of hemobilia.

PTC: percutaneous transhepatic cholangiography; PTBD: percutaneous transhepatic biliary drainage; ERCP: endoscopic retrograde cholangiopancreatography; EUS: endoscopic ultrasound; FNA: fine needle aspiration; RFA: radiofrequency ablation; TACE: transarterial chemoembolization. [5,12,14,16,17,20] Figure created with BioRender. All credits to Aarfa Devani, September 2024.