The Korean Journal of Gastroenterology (대한소화기학회지)

The Korean Society of Gastroenterology (대한소화기학회)
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Etiology, Clinical Features, and Endoscopic Management of Hemobilia: A Retrospective Analysis of 37 Cases

혈액담즙증의 병인, 임상적 특징 및 내시경적 치료: 37예의 후향적 분석

  • Kim, Kook-Hyun (Department of Internal Medicine, CHA Gumi Medical Center, CHA University) ;
  • Kim, Tae-Nyeun (Department of Internal Medicine, Yeungnam University College of Medicine)
  • 김국현 (차의과학대학교 구미차병원 내과학교실) ;
  • 김태년 (영남대학교 의과대학 내과학교실)
  • Published : 2012.04.25
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Abstract

Background/Aims: Hemobilia is a rare cause of upper gastrointestinal bleeding. Endoscopic retrograde cholangiopancreaticography (ERCP) is considered to be an excellent diagnostic and treatment modality. Thirty-seven cases of hemobilia with different underlying pathologies were analyzed to illustrate clinical features and to evaluate the role of endoscopic management. Methods: A total of 37 patients (26 men and 11 women; mean age, 66.2${\pm}$15.3 years) who were confirmed to have hemobilia by ERCP in a single center from 2000 to 2010 were reviewed retrospectively. Patients with iatrogenic causes of hemobilia were excluded in this study. Results: The causes of hemobilia were hepatocellular carcinoma in 14, bile duct and gallbladder malignancies in 12, common bile duct stones with cholangitis in 4, acute cholecystitis in 4, and pancreatic cancer in 2 patients. The clinical features of hemobilia were jaundice (89.2%), abdominal pain (78.4%), and melena (13.5%). The cholangiographic findings of hemobilia were amorphous filling defects in 15, tubular filling defects in 6, and cast-like filling defects in 6 patients. Endoscopic management included endoscopic nasobiliary drainage in 26 patients and endoscopic retrograde biliary drainage in 7 patients. Biliary obstruction caused by hemobilia was successfully treated with endoscopic biliary drainages in most cases. Conclusions: The most common non-iatrogenic causes of hemobilia were hepatobiliary malignancies, and the majority of patients presented with jaundice and abdominal pain. Endoscopic biliary drainage is recommended as the initial management to control biliary obstruction.

Keywords

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