Operations for massive haemobilia in an Indian hospital
Kumar, Mudit; Gupta, S.; Soni, A.S. and Nundy, S. (2002) Operations for massive haemobilia in an Indian hospital. In: The XIIth Annual Conference of Indian Association ofSurgical Gastroentrology, 2002.
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Massive haemobilia carries a mortality of 25% in western countries. Its aetiology has changed over decades from accidental to iatrogenic trauma like percutaneous biopsy and biliary drainage. The management protocol is unclear. The reports from India are few. Patients and Methods: Between July 1997 and July 2002 we prospectively studied 17 patients with massive haemobilia (blood requirement more than 1400ml/day) admitted to our hospital. There were 9 males and 8 females with a mean age of 42 (15 to 65) years. Results: The commonest aetiology was iatrogenic (9) including laparoscopic cholecystectomy (5), ERC, PTC, hepatic stone extraction and removal of biliary stent (1 each). The others had accidental trauma (3), visceral aneurysms (2), biliary stones (2) and chronic pancreatitis (1). The commonest clinical presentation was gastrointestinal bleeding (16). The average preoperative blood requirement was 9 (4 to 24) units. Transarterial embolisation (TAE) was attempted in 6 patients and successful in 1. Operations were performed in 16 patients for failed TAE (5), haemodynamic instability (2), portal biliopathy (1), haemoperitoneum (1) and for additional hepatobiliary conditions (7). The procedures to control bleeding were ligation of aneurysm (8), right hepatectomy (3), repair of hepatic artery (2) and lienorenal shunt, cholecystectomy and underrunning of the papilla (1 each). 4 (25%) patients died. Conclusions: In India massive haemobilia has varied aetiologies, most commonly a pseudoaneurysm after laparoscopic cholecystectomy. TAE can fail and operations are successful in 75% patients. In this country perhaps patients with massive haemobilia should undergo early surgery for definitive management.
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