Radiofrequency ablation (RFA) has been accepted as a safe and effective treatment for unresectable hepatic tumors because of the advantages of a minimally invasive procedure and the local treatment effect. Although RFA can be performed safely in most patients, early and late complications related to mechanical or thermal damage may be observed at follow-up examination. Hemobilia is a very rare complication of RFA and most hemobilia is an immediate complication. However, delayed hemobilia is an even more rare complication after RFA and is known to be a fatal complication. We present a case of delayed fatal hemobilia after RFA for hepatocellular carcinoma.
Carcinoma, Hepatocellular ; Follow-Up Studies ; Hemobilia ; Humans

Anticoagulation therapy is essential after cardiac valve surgery. However, spontaneous bleeding remains a major concern during anticoagulation therapy. Spontaneous gallbladder (GB) hemorrhage (hemobilia) is a rare occurrence during standard anticoagulation therapy. This report presents a case of GB hemorrhage that occurred shortly after initiating oral anticoagulant therapy in a patient who had undergone mitral valve replacement surgery.
Anticoagulants ; Gallbladder* ; Heart Valves* ; Hemobilia ; Hemorrhage* ; Humans ; Mitral Valve

Transcatheter arterial embolization was applied in 7 cases of hepatic disease including hemobilia of various causes and malignant tumors at Department of Radiology, Seoul National University Hospital during recent several years. The embolic materials were autologous blood clot and Gelfoam particle. Successful control of bleeding or devascularization of tumor vessel was made in 6 of the 7 patients. There was no serious complications; however, post embolization syndrome was found including pain, fever, nausea and vomiting in all cases and subsided after a few days. Transcatheter hepatic arterial embolization is suggested to be a safe and effective treatment in control of hemobilia and devascularization of malignant hepatic tumors.
Fever ; Gelatin Sponge, Absorbable ; Hemobilia ; Hemorrhage ; Humans ; Nausea ; Seoul ; Vomiting

PURPOSE: To compare the feasibility and safety of US-guided right and left percutaneous transhepatic biliary drainage (PTBD). MATERIALS AND METHODS: Between March 1998 and May 1999, 32 patients underwent 36 US-guided right or left PTBD in referred order, alternatively. The causes of biliary obstruction were bile duct stone (n=2), bile duct carcinoma (n=10), carcinoma of the pancreas (n=9), GB carcinoma (n=7), metastasis to the porta hepatis (n=3), and carcinoma of the ampulla of vater (n=1). Technical success, procedure time, fluoroscopic time, and complications were evaluated. RESULTS: PTBD was successful in 94% of both right and left approach. The average procedure time was 9.7+/-3.8 min. in the right approach and 9.6+/-3.1 min. in the left approach, respectively (p=0.794). The average fluoroscopic time were 3.9+/-2.4 min. in the right approach and 3.8+/-2.2 min. in the left approach (p=0.892). A major complication, bile peritonitis, occurred in one of 16 patient with right-sided approach. Minor complications occurred in six right (2 hemobilia, 3 tube malfunction, 1 cholangitis) and three left (1 hemobilia, 1 fever, 1 cholangitis) PTBD. There were no significant difference in the complication rates between right and left PTBD (p=0.729). CONCLUSION: There were no significant differences in feasibility and safety in US-guided right and left PTBD.
Ampulla of Vater ; Bile ; Bile Ducts ; Drainage* ; Fever ; Hemobilia ; Humans ; Neoplasm Metastasis ; Pancreas ; Peritonitis

PURPOSE: To report X-shaped stent insertion and its result in the patients with advanced hilar malignancy. MATERIALS AND METHODS:X-shaped stents were inserted in six patients with advanced hilar malignancy involving segmental branches of both intrahepatic bile ducts (IHD). The causes were cholangiocarcinomas in five patients and recurrent GB cancer in one. The procedure includes three steps: 1) the insertion of two wires through three IHDs in an X configuration, using a stone basket; 2) balloon dilatation of lesions, and 3) the in-sertion of two stents in an as X configuration. Stents were inserted after balloon dilatation in five patients, and without balloon dilatation in one. Changes in serum bilirubin levels and procedure-related problems were reviewed. RESULTS: In all patients, serum bilirubin levels gradually decreased, but in two, they increased again. One of these two died of sepsis after 1 month. There was bile leakage through the puncture and bile was extracted from malignant ascites. In the other patient, occlusion of the left stent tip occurred, and additional left PTBD was performed 3 months later. Hemobilia developed in all five patients with balloon dilatation, these all experianced pain during dilatation , but afterwards this disappeared. One stent without pre-balloon dilation showed incomplete self-expansion at the crossing part and supplementary balloon dilatations were performed. CONCLUSION: In patients with advanced hilar malignancy, X-shaped stent insertion is a new palliation. Problems such as hemobilia, pain, and intraperitoneal bile leakage may, however, occur.
Ascites ; Bile ; Bile Ducts, Intrahepatic ; Bilirubin ; Cholangiocarcinoma ; Dilatation ; Hemobilia ; Humans ; Punctures ; Sepsis ; Stents*

Clonorchiasis is a trematodasis caused by ingestion of a raw fish that contains the infective cysts. In cases of early infection, the patients complained non-specific gastrointestinal symptoms, including anorexia, epigastric pain or diarrhea. In cases of long-standing infection, an association with gallstones, choledocholithiasis, cholangitis and cholangiocarcinoma has been reported. However, acute hemorrhagic complications of clonorchiasis are extremely rare. Herein, we report on a case of hemobilia that was caused by Clonorchis sinensis, and this was confirmed by operation.
Anorexia ; Cholangiocarcinoma ; Cholangitis ; Choledocholithiasis ; Clonorchiasis ; Clonorchis sinensis ; Diarrhea ; Eating ; Gallstones ; Hemobilia ; Humans

Hemobilia is a cause of obscure gastrointestinal hemorrhage. Most cases have an iatrogenic or traumatic origin but cases of hemobilia with non-traumatic causes are rare. The non-traumatic causes of hemobilia are inflammation, gallstones, neoplasm and vascular lesions. Currently, various therapeutic options are available for hemobilia, and transarterial embolization is now the first line of intervention used to stop the bleeding of hemobilia, which shows a high success rate of approximately 80% to 100% with a lower morbidity and mortality rate than with surgery. We report a rare case of non-traumatic hemobilia caused by a pseudoaneurysm of the hepatic artery that was successfully treated with transarterial embolization.
Aneurysm, False* ; Gallstones ; Gastrointestinal Hemorrhage ; Hemobilia* ; Hemorrhage ; Hepatic Artery* ; Inflammation ; Mortality

PURPOSE: To evaluate the usefulness of percutaneous transhepatic biliary drainage (PTBD) tract dilatation using a Nipro set. MATERIALS AND METHODS: We dilated 28 percutaneous biliary drainage tracts up to 18F ; 26 procedures involved PTBD, and two, cholecystostomy. A Nipro set was used for dilatation, the purposes of which were stone removal (n=18) and choledochoscopic biposy (n=10). For dilatation, local anesthesia was used in all cases. RESULTS: In all patients, tract dilatation was successful. In 21 of 28 cases, dilatation of the right PTBD tract was involved, and in five of 28, dilatation of the left tract. In two cases, tract dilatation was done in cholecystostomy tracts. Complications encountered were pain (n=17), bradycardia (n=2), hemobilia (n=2), bleeding (n=1)and fever (n=1). CONCLUSION: In choledocoscopy, tract dilatation using a Nipro set is safe and simple.
Anesthesia, Local ; Biliary Tract* ; Bradycardia ; Cholecystostomy ; Dilatation* ; Drainage ; Fever ; Hemobilia ; Hemorrhage ; Humans

Cholangiocarcinoma is a rare tumor among all populations of the world and accounts for less than 2% of cancers found at autopsy and between 10% and 20% of all primary liver cancers. The tumor originates either from the intrahepatic small duct radicles(peripheral type) or the major hepatic ducts at or near the junction of the right and left hepatic ducts(hilar type). Included in the latter are the small intraduct carcinomas arising at the bifurcation of the hepatic ducts. (continue...)
Autopsy ; Cholangiocarcinoma* ; Cholangiopancreatography, Endoscopic Retrograde ; Hemobilia* ; Hepatic Duct, Common ; Humans ; Jaundice, Obstructive* ; Liver Neoplasms

Hemobilia is a rare gastrointestinal bleeding, usually caused by injury to the bile duct. Hemobilia after endoscopic retrograde cholangiopancreatography (ERCP) is generally self-limiting and patients will spontaneously recover, but some severe and fatal hemorrhages have been reported. ERCP-related bowel or bile duct perforation should be managed promptly, according to the type of injury and the status of the patient. We recently experienced a case of late-onset severe hemobilia in which the patient recovered after endoscopic biliary stent insertion. The problem was attributable to ERCP-related bile duct perforation during stone removal, approximately 5 weeks prior to the hemorrhagic episode. The removal of the stent was performed 10 days before the onset of hemobilia. The bleeding was successfully treated by two sessions of transarterial coil embolization.
Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Embolization, Therapeutic ; Hemobilia* ; Hemorrhage ; Humans ; Plastics* ; Stents*