Department of Surgery, Lady Hardinge Medical College, New Delhi, India.
BMC Gastroenterol. 2013 Mar 3;13:43. doi: 10.1186/1471-230X-13-43.
Haemobilia usually occurs secondary to accidental or iatrogenic hepatobiliary trauma. It can occasionally present with cataclysmal upper gastrointestinal haemorrhage posing as a life threatening emergency. Haemobilia can very rarely be a complication of acute cholecystitis. Here we report a case of haemobilia manifesting as massive gastrointestinal haemorrhage in a patient without any prior history of biliary surgery or intervention and present a brief review of literature.
A 22 year old male admitted with history suggestive of acute cholecystitis subsequently developed waxing waning jaundice and recurrent episodes of upper gastrointestinal bleed. Endoscopy showed an ulcer in the first part of duodenum with a clot, no active bleed was visible. Angiography was suggestive of a ruptured pseudoaneurysm in the vicinity of the right hepatic artery probably originating from the cystic artery. Coil embolization was tried but the coil dislodged into the right branch of hepatic artery distal to the site of pseudoaneurysm. Review of angiographic video in light of operative findings demonstrated a fistulous communication between cystic artery and gallbladder as the cause, a simultaneous cholecystoduodenal fistula was also noted. Retrograde cholecystectomy, closure of cholecystoduodenal fistula and right hepatic arteriotomy with retrieval of the endo-coil and hepatic arterial repair was performed.
Fistula between the cystic artery and gallbladder has been commonly reported to occur after laparoscopic cholecystectomy. Spontaneous fistulous communication, i.e. in the absence of any prior trauma or intervention, between cystic artery and gallbladder is rare with very few reports in literature. Aetiopathogenesis of the disease, in the context of current literature is reviewed. The diagnostic dilemma posed by the confounding finding of an ulcer in the duodenum, the iconic video angiographic depiction as also the therapeutic challenge of a failed embolization with consequent microcoil migration and primary hepatic arterial repair in the emergency situation is discussed.
胆道出血通常继发于意外或医源性肝胆创伤。它偶尔会表现为灾难性的上消化道出血，构成危及生命的紧急情况。胆道出血非常罕见是急性胆囊炎的并发症。在此，我们报告一例胆道出血表现为大量胃肠道出血的病例，该患者无任何胆道手术或干预的既往史，并简要回顾了文献。
一名 22 岁男性，因急性胆囊炎病史入院，随后出现间歇性黄疸和反复上消化道出血。内镜检查显示十二指肠第一段有一个溃疡，伴有血栓，没有可见的活动性出血。血管造影显示右肝动脉附近可能起源于胆囊动脉的破裂假性动脉瘤。尝试进行线圈栓塞，但线圈在假性动脉瘤部位的右肝动脉分支处脱落。根据手术结果回顾血管造影视频显示，胆囊动脉和胆囊之间存在瘘管，这是导致瘘管的原因，同时还注意到胆囊十二指肠瘘。进行逆行胆囊切除术、胆囊十二指肠瘘闭合、右肝动脉切开术，取出腔内线圈，并进行肝动脉修复。
腹腔镜胆囊切除术后胆囊动脉和胆囊之间的瘘管已被广泛报道。在没有任何先前创伤或干预的情况下，胆囊动脉和胆囊之间自发的瘘管沟通很少见，文献报道也很少。在当前文献的背景下，回顾了疾病的病因发病机制。讨论了在十二指肠溃疡这一混杂发现的诊断难题、标志性的血管造影视频描述，以及在紧急情况下栓塞失败、微线圈迁移和原发性肝动脉修复的治疗挑战。
