From the Guidelines
Haemobilia manifests as the classic triad of upper abdominal pain, gastrointestinal bleeding, and jaundice, though all three symptoms occur together in only 22-35% of cases. The bleeding typically presents as melena (black, tarry stools) or hematemesis (vomiting blood), and can range from occult bleeding to life-threatening hemorrhage. Patients may experience biliary colic-like pain due to blood clots passing through the biliary tract. Jaundice develops when blood clots obstruct bile flow. Other manifestations include hemodynamic instability in severe cases, with tachycardia and hypotension. Laboratory findings often show anemia, elevated liver enzymes, and hyperbilirubinemia. The condition most commonly results from iatrogenic causes like liver biopsy or percutaneous biliary procedures, though trauma, tumors, inflammatory conditions, and vascular malformations can also cause it. Diagnosis typically requires endoscopy to visualize blood emerging from the ampulla of Vater, with CT angiography or selective hepatic angiography being the gold standard for identifying the bleeding source, as seen in studies such as 1. Prompt recognition is essential as severe haemobilia can lead to significant morbidity and mortality if not properly managed.
Some key points to consider in the management of haemobilia include:
- The importance of prompt recognition and treatment to prevent significant morbidity and mortality
- The use of endoscopy and CT angiography or selective hepatic angiography for diagnosis
- The potential for iatrogenic causes, such as liver biopsy or percutaneous biliary procedures
- The need for hemodynamic stability and intensive resuscitation in severe cases
- The potential for hemodynamic instability, with tachycardia and hypotension, as seen in studies such as 1
It is also important to note that haemobilia can be a rare cause of upper gastrointestinal bleeding, as mentioned in studies such as 1, and that other causes of bleeding, such as ulcers or varices, should also be considered in the differential diagnosis. However, the classic triad of symptoms and the presence of blood clots in the biliary tract can help to distinguish haemobilia from other causes of bleeding. Overall, prompt recognition and treatment of haemobilia are essential to prevent significant morbidity and mortality, and a thorough understanding of the condition and its management is critical for clinicians.
From the Research
Manifestation of Haemobilia
Haemobilia can manifest in various ways, including:
- Upper gastrointestinal bleeding, which can be overt or occult 2, 3, 4, 5, 6
- Right upper quadrant pain, which is a common symptom of haemobilia 3, 4, 5
- Jaundice, which can occur due to blood in the biliary tract 3, 4, 5
- Melena and hematemesis, which can occur in some cases of haemobilia 2, 5
- A classic triad of right upper quadrant pain, jaundice, and overt upper gastrointestinal bleeding, known as Quincke's triad, although this is only present in 25-30% of patients with haemobilia 3, 4
Clinical Presentation
The clinical presentation of haemobilia can vary depending on the underlying cause and severity of the condition. Some common symptoms and signs include:
- Epigastric and right hypochondria pain 2
- Nausea and vomiting 2
- Decrease in haemoglobin level 2
- Biliary drainage with blood 2
- Melena and hematemesis 2, 5
Diagnosis and Treatment
Diagnosis of haemobilia depends on a high index of suspicion based on the patient's clinical presentation and history of recently undergoing hepatopancreatobiliary intervention or having other predisposing factors. Treatment options range from supportive medical care to urgent advanced endoscopic, interventional radiologic, or surgical intervention 3, 4, 5, 6. Interventional angiography remains the first treatment option for haemobilia, with selective arterial ligation or hepatectomy as options in case of lack of angiography or insufficient results after embolization 2.