Document Detail


Atraumatic hemobilia arising from a cirrhotic liver.
MedLine Citation:
PMID:  2662459     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Biliary hemorrhage may occur in a variety of clinical settings, but spontaneous hemobilia has not been reported from a cirrhotic liver. We describe a case of major hepatic hemobilia in a patient with cirrhosis and no history of trauma. A 50-year-old woman had abdominal pain, melena, and profound anemia. An extensive workup did not show the site of bleeding but did show a mass in the gallbladder. Cholecystectomy was performed, and at operation the patient was found to have cirrhosis and portal hypertension. The gallbladder "mass" was simply an organized clot, and hemorrhage recurred postoperatively. On reoperation, bleeding from the ampulla of Vater was observed, confirming the diagnosis of hemobilia. She was treated with angiographic interruption of hepatic arterial flow, at which time bleeding ceased. Her total transfusion requirements included 46 units of blood. Through 16 months of follow-up the patient has had no recurrent bleeding and no evidence of encephalopathy. This case demonstrates that spontaneous hemobilia may indeed arise from a cirrhotic liver. Proximal interruption of arterial flow is usually not recommended for hemobilia, especially in the presence of portal hypertension and cirrhosis, but may be life-saving in selected patients.
Authors:
S W Merrell; J J Gilbertson; D Albo; S J Mintz
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Surgery     Volume:  106     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  1989 Jul 
Date Detail:
Created Date:  1989-08-01     Completed Date:  1989-08-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  105-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Utah College of Medicine, Salt Lake City 84132.
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MeSH Terms
Descriptor/Qualifier:
Cholecystectomy
Female
Gallbladder Diseases / diagnosis,  etiology,  surgery*
Hemorrhage / diagnosis,  etiology,  surgery*
Humans
Liver Cirrhosis / complications*
Middle Aged
Ultrasonography

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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