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CN 22-1108/R
Volume 40 Issue 10
Oct.  2024
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Article Navigation >  Journal of Clinical Hepatology  > 2024  >  40(10): 2070-2074

Imaging features and therapeutic strategies for lethal iatrogenic hemobilia

DOI: 10.12449/JCH241022
  • a.

    Department of Digestive Endoscopy, Jiangsu Provincial People’s Hospital/The First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China

  • b.

    Department of Interventional Radiology，Jiangsu Provincial People’s Hospital/The First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China

Research funding:

National Natural Science Foundation of China (82000621)

More Information
  • Corresponding author: WANG Chen， chenwang0112@126.com （ORCID： 0009-0000-0809-6500）; FAN Zhining， njmu_fzn@163.com （ORCID： 0009-0003-6000-5057）
  • Received Date: 2024-01-26
  • Accepted Date: 2024-03-25
  • Published Date: 2024-10-25
    Abstract
  •   Objective  To investigate the imaging features and pathogenesis of lethal iatrogenic hemobilia （LIH） and the value of transarterial intervention in the treatment of LIH.  Methods  A total of 269 patients with upper gastrointestinal bleeding who were admitted to The First Affiliated Hospital of Nanjing Medical University from August 2009 to July 2023 were enrolled， among whom 24 had a confirmed diagnosis of LIH and received treatment， and a retrospective analysis was performed for the clinical data of these 24 patients， including the iatrogenic causes， angiographic findings， and arterial interventions of LIH. Among the 24 patients， 23 received transarterial embolization （TAE） with gelatin sponge particles and coils， and 1 received a covered stent for isolation. The main criteria for assessing treatment outcome included the technical success rate of surgery， procedure-related complications， and long-term clinical follow-up.  Results  Among the 24 patients with LIH， 12 had LIH caused by interventional procedures， and 12 had LIH caused by hepatobiliary and pancreatic surgery. The main clinical manifestations included a significant reduction in blood pressure or a persistent reduction in hemoglobin in 13 patients and upper gastrointestinal bleeding in 18 patients. Among the 24 patients， 2 developed symptoms during surgery， 4 developed symptoms within 24 hours， and 18 developed symptoms after 24 hours. Angiography showed a positive bleeding rate of 100% （24/24）， and imaging findings included pseudoaneurysms in 15 patients， hepatic artery truncation in 3 patients， extravasation of contrast medium in 5 patients， and hepatic arteriobiliary fistula in 3 patients. Among the 24 patients， 23 received TAE and 1 received stent implantation. Successful hemostasis was achieved for 23 patients， with a technical success rate of 95.8% （23/24）. Four patients developed hepatic necrosis and abscess after TAE， and there was no rebleeding or recurrence after hemostatic treatment.  Conclusion  Various iatrogenic injuries may result in LIH with diverse clinical and imaging findings， and integrated diagnostic imaging combined with transarterial intervention is the best effective life-saving measure for LIH.

     

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