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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Abstract

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.

EPrint Type:	Conference or Workshop Item (Paper)
Uncontrolled Keywords:	Massive Haemobilia, Surgery, Management, Mortality, Etiology, Laparoscopic Cholecystectomy, Males, Females, Hospital, Precutaneous Biopsy, Biliary Drainage, Gastrointestinal Bleeding
Subjects:	Surgical Procedures, Operative > Digestive System Surgical Procedures Pathological Conditions, Signs and Symptoms > Pathologic Processes > Hemorrhage Surgical Procedures, Operative > Biopsy Therapeutics > Drainage Surgical Procedures, Operative > Drainage Health Occupations > Medicine > Specialties, Surgical > Surgery -Institutional Repositories > Sir Ganga Ram Hospital, New Delhi Surgical Procedures, Operative > Surgical Procedures, Minimally Invasive > Endoscopy > Laparoscopy
ID Code:	2520
Deposited By:	Sir Ganga Ram Hospital
Deposited On:	28 December 2007

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