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Haemobilia

Haemobilia refers to the presence of blood in the biliary tree.

Clinical presentation

The classical clinical triad, only seen in ~50% of cases, consists of:

  1. melaena (i.e. upper gastrointestinal bleeding)
  2. jaundice
  3. abdominal pain

Pathology

Aetiology
  • iatrogenic: surgical or percutaneous procedures (~67%)
  • trauma (~5%)
  • vascular malformations (7%)
    • e.g. hepatic artery aneurysm or arteriovenous malformation
    • can cause massive haemobilia
  • malignancy: most commonly hepatocellular carcinoma
  • abscess formation
  • gastrointestinal bleed due to gallstones

Radiographic features

Ultrasound

Ultrasound is often the first investigation and reveals echogenic material in the bile ducts and dilated gallbladder.

CT
  • high-attenuation clot within the bile ducts

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