Hepatic artery angiography and embolization for hemobilia after hepatobiliary surgery

Objective To evaluate the effectiveness of hepatic angiography and embolization in the dia gnosis and treatment of hemobilia after hepatobiliary surgery. Methods Nine patients had upper gastrointestinal bleeding 7 days to 3 months after surge ry. They underwent emergency hepatic artery angiography and were treated by emb olization using Gelfoam particles only (8 patients) and Gelfoam particles plus m icrocoils (1 patient). Results Hepatic artery angiography revealed hepatic artery pseudoaneurysms in 3 p atients, diffuse hemorrhage of the hepatic artery branches in 3, right hepat ic artery-bile duct fistulas in 2, and hepatic artery-small intestine fistul a in 1. Hemobilia was controlled with embolization in 7 patients, of whom 1 had r ecurrent bleeding 1 day after treatment. During the follow-up, 3 patients died of multiple organ dysfunction syndrome. Two patients whose hemorrhage could no t be controlled due to technical reasons died several days later. Conclusion When hemobilia after hepatobiliary surgery is suspected, patients should receive hepatic angiography as a first diagnostic procedure and be tre ated with minimally invasive procedure of selective embolization of the involv ed artery as soon as possible.