Biliary Tract: Hemobilia & Pneumobilia
Hemobilia
Basics
- Definition: Bleeding within Biliary Tract
- Quinke’s Triad: Upper GI Bleed, Jaundice & RUQ Pain
Causes
- Iatrogenic (Most Common)
- Causes:
- ERCP/Sphincterotomy
- Liver Bx
- TIPS
- Results from an Arterobiliary Fistula Between CBD & Hepatic Artery (Pseudoaneurysm)
- Causes:
- Trauma
- Gallstones
- Infection
- Malignancy
Diagnosis
- First Test: EGD (Rule Out Other Source)
- Angiography Allows Dx & Tx
- May Consider CTA
Treatment
- Unstable: Angioembolization
- Surgery if Fails
- Stable:
- Minor Bleeding: Conservative Management
- Major Bleeding: Angioembolization vs Endoscopy
- Endoscopic Options – Balloon Tamponade, Epinephrine Injection, Electrocoagulation or Hemoclip
- Surgery if Fails
Bleeding from the Ampulla of Vater 1
Pneumobilia
Definition
- Air within Biliary Tract
Comparison to Portal Venous Gas
- Pneumobilia:
- Centrally Located
- Centripetal Distribution from Biliary Anatomy and the Direction of Bile Flow
- Portal Venous Gas:
- Peripherally Located
- Centrifugal Distribution from Biliary Anatomy and the Direction of Blood Flow
- Mnemonic:
- P-P: Portal Venous Gas is Peripheral
- C-C: Common Bile Duct Gas is Central
Causes
- ERCP (Most Common)
- Incompetent Sphincter of Oddi (Sphincterotomy, Gallstone, Scarring)
- Biliary-Enteric Fistula (Gallstone Ileus)
- Biliary-Enteric Anastomosis (Whipple, Choledochojejunostomy)
- Infection (Rare)
Treatment
- No Specific Treatment Required
- Treat Any Underlying Pathology
Pneumobilia 2
References
- Alis H, Bozkurt MA, Oner OZ, Dolay K, Turhan AN, Uçar A, Inci E, Aygun E. Case report: acute pancreatitis caused by postcholecystectomic hemobilia. BMC Gastroenterol. 2010 Jul 7;10:75. (License: CC BY-2.0)
- Zeuge U, Fehr M, Meyenberger C, Sulz MC. Mind the sump! – diagnostic challenge of a rare complication of choledochoduodenostomy. Case Rep Gastroenterol. 2014 Nov 13;8(3):358-63.(License: CC BY-NC-3.0)
