Hemobilia: historical overview, clinical update, and current practices复制标题

胆道出血: 历史概述、临床更新和当前实践

Hemobilia refers to macroscopic blood in the lumen of the biliary tree. It represents an uncommon, but important, cause of gastrointestinal bleeding and can have potentially lethal sequelae if not promptly recognized and treated. The earliest known reports of hemobilia date to the 17th century, but due to its relative rarity and challenges in diagnosis, it has historically not been well-studied. Until recently, most cases of hemobilia were due to trauma, but the majority now occur as a sequelae of invasive procedures involving the hepatopancreatobiliary system. A triad (Quincke’s) of right upper quadrant pain, jaundice, and overt gastrointestinal bleeding has been classically described in hemobilia, but it is present in only a minority of patients. Therefore, prompt diagnosis depends critically on a high index of suspicion based on a patient’s clinical presentation and a history of recently undergoing hepatopancreatobiliary intervention or having other predisposing factors. Treatment of hemobilia depends on the suspected source and clinical severity and thus ranges from supportive medical care to urgent advanced endoscopic, interventional radiologic, or surgical intervention. In the present review, we provide a historical perspective, clinical update, and overview of current trends and practices pertaining to hemobilia.

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