Kawaguchi Yoshiaki, Ogawa Masami, Maruno Atsuko, Ito Hiroyuki, Mine Tetsuya
Department of Gastroenterology, Tokai University School of Medicine, Isehara, Japan.
Case Rep Oncol. 2012 Sep;5(3):682-6. doi: 10.1159/000346341. Epub 2012 Dec 22.
Hemobilia represents gastrointestinal bleeding that develops as a result of communication between blood vessels and the biliary tract, which causes the blood to reach the duodenal papilla. It is characterized by biliary colic as the initial symptom, and the complications of cholangitis, obstructive jaundice and/or anemia. In general, definitive diagnosis is made by esophagogastroduodenoscopy which confirms bleeding from the duodenal papilla. Abdominal US and abdominal enhanced CT are performed to identify the source of the bleeding, as well as ERCP for biliary drainage to control the comorbid cholangitis. If active hemorrhage accompanied by worsening of the anemia is suspected, abdominal angiography is performed to selectively image the hepatic artery. Then, embolization of the culprit vessel is recommended. In our patients with difficult hemostasis, because of the direct compression hemostasis to the tumor site achieved with the fully covered metallic stent and secondary compression hemostasis due to blood clots, the bleeding could be controlled.
胆道出血是指由于血管与胆道之间形成交通，致使血液到达十二指肠乳头而引发的胃肠道出血。其特征是以胆绞痛为首发症状，并伴有胆管炎、梗阻性黄疸和/或贫血等并发症。一般而言，通过食管胃十二指肠镜检查确诊十二指肠乳头出血来明确诊断。进行腹部超声和腹部增强CT以确定出血来源，同时行内镜逆行胰胆管造影术（ERCP）进行胆道引流以控制合并的胆管炎。如果怀疑有活动性出血并伴有贫血加重，则进行腹部血管造影以选择性地显示肝动脉。然后，建议对肇事血管进行栓塞。在我们止血困难的患者中，由于完全覆盖的金属支架对肿瘤部位实现了直接压迫止血以及血栓形成导致的继发性压迫止血，出血得以控制。
