HAEMOBILIA – A RARE CAUSE OF HAEMATEMESIS

Haemobilia

Abstract

Introduction

Haemobilia a term introduced by Sandblom in 19481 [1], refers to a relatively common but under-diagnosed and occasionally severe clinical problem. Sandblom recognized the classical triad of pain, jaundice and haematemesis. The more common causes of haemobilia reflect advances in hepatobiliary diagnostic and therapeutic techniques [2-4]. The communication between the vascular and the biliary system may be caused by laceration, pressure necrosis, tumour or infection. Because of its high pressure, the arterial system is involved more often than the venous system. The classical triad is not present in every patient. Jaundice, biliary colic or haematemesis each have two-third incidence [3]. Acute bleeding first causes pain, followed by haematemesis or melena. Liver or biliary scans, ultrasonography (USG), computerised tomography (CT) scan or magnetic resonance imaging (MRI) may provide helpful information, such as evidence of anatomic defects or abnormalities in the liver or biliary ducts [5-7]. Endoscopy may be helpful in half of the cases [8]. In the setting of trauma, the diagnosis may be missed until the re-exploration due to unexplained haematemesis [9]. Initial management remains the same in all cases. Patient should be resuscitated to treat hypovolumia and shock. Further management and selection of operative versus non-operative treatment is based on severity of bleeding, clarity of diagnosis, the underlying cause, age and general health of the patient. The options range from expectant treatment, arteriographic technique to operative procedures [10].