Abstract
A 59 year-old woman with liver cirrhosis due to hepatitis C, complicated by refractory hepatic hydrothorax was treated with a TIPS (transjugular intrahepatic portosystemic shunt) procedure. The procedure was complicated by substantial gastrointestinal hemorrhage. EGD (esophagogastroduodenoscopy) was performed and revealed hemobilia. A hepatic angiogram was then performed revealing a fistulous tract between a branch of the hepatic artery and biliary tree. Bleeding was successfully stopped by embolization of the bleeding branch of the right hepatic artery. Hemobilia is a rare cause of upper gastrointestinal bleeding with an increasing incidence due to the widespread use of invasive hepatobiliary procedures. Hemobilia is an especially uncommon complication of TIPS procedures. We recommend that in cases of hemobilia after TIPS placement, a physician should immediately evaluate the bleeding to exclude an arterio-biliary fistula.
Highlights
The term hemobilia was first coined by Sandblom [1], when he described bleeding into the biliary tree following trauma
We report iatrogenic hemobilia as a complication of Transjugular intrahepatic portosystemic shunt (TIPS)
Physicians should be aware of hemobilia as one of the possible complications of TIPS and should be experienced in its management
Summary
The term hemobilia was first coined by Sandblom [1], when he described bleeding into the biliary tree following trauma. Hemobilia has become widely recognized due to the improvements in diagnostic modalities and an increased index of clinical suspicion for the disorder. Hemobilia occurs when a fistula forms between a vessel of the splanchnic circulation (hepatic artery or portal vein) and the intrahepatic or extra-hepatic biliary system. Common causes include iatrogenic manipulation of the hepatobiliary system and trauma [2]. Management of hemobilia is aimed to stop bleeding, maintain continuous flow through the biliary system and treat the underlying etiology. Iatrogenic hemobilia after TIPS (transjugular intrahepatic portosystemic shunt) is extremely uncommon but several cases have been reported. We report iatrogenic hemobilia as a complication of TIPS procedure [6], which was successfully managed by transarterial embolization
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