Hemobilia Post Liver Biopsy: Mechanism, Presentation, Complications and Management

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Background: Liver biopsy is the gold standard for diagnosing various liver pathology. However, it may be associated with serious complications such as hemobilia, information of which is scarce in the literature. Objective: This article intends to review various aspects of hemobilia including the mechanism, presentation, diagnosis and management. Method: Literature review. A systematic review of the literature was performed by searching the PubMed and Medline databases, for all relevant articles in English on hemobilia, published from 1963 to June 2015. Discussion: The search resulted in retrieval of 56 studies, involving 78 patients with hemobilia. The method of biopsy included percutaneous(51.8%), ultrasound guided percutaneous biopsy(29.6%), transjugular(11.1%), laparoscopic biopsy(3.7%). The predominant symptom of presentation was pain and GI bleed(42.2%), Quincke’s triad(39.4%). The mean day of presentation was 5 days. The investigations carried out included angiogram(68%),LFT(47.9%), ultrasound abdomen(45.2%), ERCP(24.6%), endoscopy(16.4%). The vascular anomaly contributing to hemobilia were arteriobiliary fistula(32.6%), arterioportal fistula(36.9%), pseudoaneurysm(21.7%) and arteriovenous biliary fistula(trifistula) (4.3%). Transarterial embolization was carried out in 61.2% of patients with 80% success in arresting bleeding. ERCP with clot extraction was carried out in 20.9%. Surgical intervention included cholecystectomy (23%), CBD exploration and clot extraction (9.23%) and hepatic artery ligation (right or left branch)(9.23%). The complications observed were pancreatitis (41.8%), hemocholecystitis(21.8%), cholangitis(10.9%). Death was seen in 3.6% of patients. Conclusion: Hemobilia is a rare complication post liver biopsy . Angiogram is both diagnostic and therapeutic. Surgical interventions is limited to those who fail to respond to arterial embolization or develop complications in the gall bladder or CBD.