Hemobilia refers to the presence of blood in the biliary tree.
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Clinical presentation
The classical clinical triad, only seen in ~50% of cases, consists of:
- melena (i.e. upper gastrointestinal bleeding)
- jaundice
- abdominal pain
Pathology
Etiology
- iatrogenic: surgical or percutaneous procedures (~67%)
- trauma (~5%)
- associated with pseudoaneurysm formation from central liver trauma
- may manifest several (2-4) weeks after the initial injury
- vascular malformations (7%)
- e.g. hepatic artery aneurysm or arteriovenous malformation
- can cause massive hemobilia
- malignancy (e.g. hepatocellular carcinoma - most common, gallbladder metastases)
- 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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