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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/01/20 03:39:30」(JST)

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Alternative names
Haemobilia Haemorrhage in bile Hematobilia Hemobilia Hemobilia (disorder) Hemorrhage in bile

Haemobilia is a medical condition of bleeding into the biliary tree. Haemobilia occurs when there is a fistula between a vessel of the splanchnic circulation and the intrahepatic or extrahepatic biliary system. It can present as acute upper gastrointestinal(UGI) bleeding. It should be considered in upper abdominal pain presenting with UGI bleeding especially when there is a history of liver injury or instrumentation.

First recorded in 1654 by Francis Glisson, a Cambridge professor.^[1]

Causes

The causes of Haemobilia include trauma (which can be accidental or iatrogenic due to procedures such as cholecystectomy), instrumentation (especially after ERCP), gallstone, inflammatory conditions ranging from ascariasis to PAN, vascular malformation, tumors, coagulopathy, and liver biopsy.^[2]

Clinical feature

"Quinke's" triad of upper abdominal pain, upper gastrointestinal haemorrhage and jaundice^[3] is classical but only present in 22% cases.^[4]

It can be immediately life-threatening in major bleeding. However, in minor haemobilia, patient is haemodynamically stable despite significant blood loss being apparent.^[4]

Investigation

Combination of EGD, CT scan and angiography depending on clinical situation, bearing in mind that haemobilia may present many days after injury. Cholangiography is performed if there is a percutaneous access or if ERCP is undertaken.

Management

Most bleeding from instrumentation are minor and would settle spontaneously.

When indicated, management is directed towards stopping bleeding and relieving obstruction if present, which is achieved either by surgical ligation of hepatic artery or by endoscopic embolisation. Endoscopic trans-arterial embolisation (TAE) is preferred initially because of high success rate and less complication. TAE involves the selective catheterization of a hepatic artery followed by embolic occlusion. Surgery is indicated when TAE has failed or sepsis present in biliary tree or drainage has failed.

References

^ Francis Glisson, (1993). From Anatomia hepatis (the Anatomy of the liver), 1654 (Cambridge Wellcome texts and documents). Cambridge: Wellcome Unit for the History of Medicine. ISBN 0-9516693-3-8. OCLC 33046433.
^ Sargent, Suzanne (2009). Liver Diseases; An essential guide for nurses and healthcare professionals. Willey-Blackwell. pp. 24–25.
^ Quincke, H. (1871). "Ein Fall von Aneurysma der Leberarterie". Berl Klin Wochenschr 30: 349–352.
^ ^a ^b Green M, Duell R, Johnson C, Jamieson N (2001). "Haemobilia". The British journal of surgery 88 (6): 773–86. doi:10.1046/j.1365-2168.2001.01756.x. PMID 11412246.

External links

CT of the abdomen with hemobilia

UpToDate Contents

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1. Causes of upper gastrointestinal bleeding in adults
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4. 経皮経肝胆管造影 percutaneous transhepatic cholangiography
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English Journal

Gallbladder bleeding-related severe gastrointestinal bleeding and shock in a case with end-stage renal disease: A case report.

Tsai JL1, Tsai SF.
Medicine.Medicine (Baltimore).2016 Jun;95(23):e3870. doi: 10.1097/MD.0000000000003870.
Gallbladder (GB) bleeding is very rare and it is caused by cystic artery aneurysm and rupture, or GB wall rupture. For GB rupture, the typical findings are positive Murphy's sign and jaundice. GB bleeding mostly presented as hemobilia. This is the first case presented with severe GI bleeding because
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Delayed Severe Hemobilia after Endoscopic Biliary Plastic Stent Insertion.

Lee SH1, Hong SG1, Lee KY1, Park PK1, Kim SD1, Lee M1, Yu DW1, Hong MY1.
Clinical endoscopy.Clin Endosc.2016 May;49(3):303-7. doi: 10.5946/ce.2015.081. Epub 2016 Mar 25.
Hemobilia is a rare gastrointestinal bleeding, usually caused by injury to the bile duct. Hemobilia after endoscopic retrograde cholangiopancreatography (ERCP) is generally self-limiting and patients will spontaneously recover, but some severe and fatal hemorrhages have been reported. ERCP-related b
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Radiofrequency ablation for biliary malignancies.

Mensah ET1, Martin J, Topazian M.
Current opinion in gastroenterology.Curr Opin Gastroenterol.2016 May;32(3):238-43. doi: 10.1097/MOG.0000000000000258.
PURPOSE OF REVIEW: Intraductal biliary radiofrequency ablation (RFA) is an emerging therapeutic modality that directly targets malignant biliary strictures during endoscopic retrograde cholangiopancreatography. This article reviews the technology, endoscopic technique, and reported outcomes of endos
PMID 27054778

Japanese Journal

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NAID 40020110210

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… で入院し血栓溶解療法を施行した．引き続きの抗凝固療法にて全身状態は改善していたが，経口摂取開始後に突然の腹痛が出現した．炎症所見と急激な肝胆道系酵素の上昇を認め，急性出血性胆嚢炎に伴うhemobiliaと診断した．抗凝固療法中でもあり，凝血塊による胆管閉塞とそれに伴う肝機能障害を考慮したため，まずは内視鏡的治療の選択となった．しかし，内視鏡治療に難渋し，胆管あるいは十二指腸穿孔が疑わ …
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安田淳吾,岡本友好,恩田真二,兼平卓,矢永勝彦
胆道 28(1), 95-100, 2014
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NAID 130004545499