Management of Hemobilia and Arterial Pseudoaneurysms

Haemobilia is an uncommon but potentially life-threatening cause of gastrointestinal bleeding, occurring when blood enters the biliary tract. It most often arises from iatrogenic injury during hepatopancreatobiliary interventions, blunt or penetrating trauma, or vascular abnormalities such as pseudoaneurysms. An arterial pseudoaneurysm develops when a breach in the arterial wall leads to a contained haematoma that remains in continuity with the parent vessel. Clinically, patients may present with right upper quadrant pain, jaundice and overt bleeding, although this classic triad is infrequently complete. Prompt diagnosis relies on a multimodal approach: contrast-enhanced CT and Doppler ultrasound can localise bleeding sources, while angiography remains the definitive tool for both diagnosis and intervention. Therapeutic strategies have shifted towards minimally invasive techniques. Transarterial embolisation using coils, liquid agents or stent grafts achieves haemostasis in the majority of cases, preserving hepatic parenchyma and reducing morbidity. Endoscopic modalities can address biliary obstruction or evacuate clots, with surgical exploration reserved for refractory haemorrhage or when complex anatomy precludes endovascular access. A multidisciplinary team comprising gastroenterologists, interventional radiologists and surgeons ensures that care is tailored to the patient’s clinical status and anatomic considerations, thereby optimising outcomes and resource utilisation.

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Management of Hemobilia and Arterial Pseudoaneurysms publication trend

The graph below shows the total number of articles in management of hemobilia and arterial pseudoaneurysms across all publications each year (not limited to Nature Index journals).

Technical terms

Haemobilia: Presence of blood within the biliary tract, often leading to gastrointestinal bleeding and obstructive jaundice.

Pseudoaneurysm: A contained disruption of the arterial wall that results in a blood-filled sac communicating with the arterial lumen.

Transarterial embolisation: A minimally invasive endovascular procedure that achieves haemostasis by occluding bleeding vessels using coils or other embolic materials.

Endovascular stent graft: A covered stent deployed within an artery to exclude pseudoaneurysms while maintaining downstream blood flow.

N-butyl 2-cyanoacrylate: A liquid adhesive embolic agent used for rapid occlusion of vascular lesions, particularly in high-flow settings.

References

1. Hemobilia: Historical overview, clinical update, and current practices. Liver International (2019).
2. Right Hepatic Artery Pseudoaneurysm Post-laparoscopic Cholecystectomy: A Case Report of Endovascular Stent-Graft Management. Cureus (2024).
3. Post-Blunt Traumatic Hemobilia From Pseudoaneurysm Successfully Treated With Embolization. Cureus (2020).