Interventional therapy for severe hemobilia after percutaneous transhepatic cholangial drainage

Abstract

Objective To investigate the effect of interventional therapy in the treatment of hemobilia after percutaneous transhepatic cholangial drainage(PTCD). Methods Six hundred and twenty-one patients with PTCD from March 2008 to January 2015 were reviewed. Eight patients (1.29%) were identified with severe hemobilia, 7 of whom underwent angiography or drainage tube radiography first, then the responsible blood vessels were detected and treated interventionally. One patient was given the emergency exploratory operation and severe hemorrhage occurred, finally undergoing interventional therapy to stop the severe hemorrhage. Results Six patients had surgical iatrogenic injury, including hepatic artery-bile duct fistulas in two patients, hepatic artery pseudoaneurysm in three patients, portal vein-bile duct fistula in one patient. Two patients with hepatic artery-bile duct fistulas and 3 with hepatic artery pseudoaneurysms underwent superselective transcatheter arterial embolization of the distal and proximal criminal artery. One portal vein-bile duct fistula patient died after the conservative treatment. Two patients with tumor thrombi in the bile duct had hemorrhage and underwent interventional therapy. Conclusion Superselective hepatic artery embolization is simple, safe and reliable in the treatment of hemobilia after PTCD. Key words: Hemobilia; Interventional therapy; Embolization; Therapeutic