Berry Rani, Han James, Girotra Mohit, Tabibian James H
Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
Department of Internal Medicine, University of California, Irvine, CA, USA.
Gastroenterol Res Pract. 2018 Jul 12;2018:3670739. doi: 10.1155/2018/3670739. eCollection 2018.
Hemobilia refers to bleeding from and/or into the biliary tract and is an uncommon cause of gastrointestinal hemorrhage. Hemobilia has been documented since the 1600s, but due to its relative rarity, it has only been more critically examined in recent decades. Most cases of hemobilia are iatrogenic and caused by procedures involving the liver, pancreas, bile ducts, and/or the hepatopancreatobiliary vasculature, with trauma and malignancy representing the two other major causes. A classic triad of right upper quadrant pain, jaundice, and overt upper gastrointestinal bleeding has been described, but this is present in only 25-30% of patients with hemobilia. Historically, the gold standard for diagnosis and treatment has been angiography and interventional radiologic intervention, respectively. However, the paradigm is shifting, at least in select cases, towards first-line reliance on noninvasive imaging (e.g., computed tomography) and therapeutic endoscopy, owing to advances in and the less invasive nature of both, while saving interventional radiological and/or surgical intervention for refractory or imminently life-threatening cases.
胆道出血是指血液从胆道流出和/或流入胆道，是胃肠道出血的一种罕见原因。自17世纪以来就有关于胆道出血的记载，但由于其相对罕见，直到最近几十年才受到更严格的审视。大多数胆道出血病例是医源性的，由涉及肝脏、胰腺、胆管和/或肝胰胆血管系统的手术引起，外伤和恶性肿瘤是另外两个主要原因。已描述了右上腹疼痛、黄疸和明显的上消化道出血这一经典三联征，但仅25%-30%的胆道出血患者出现此症状。从历史上看，诊断和治疗的金标准分别是血管造影和介入放射学干预。然而，由于非侵入性成像（如计算机断层扫描）和治疗性内镜检查的进展以及两者侵入性较小的特点，至少在某些特定情况下，范式正在转变，转向首先依赖非侵入性成像和治疗性内镜检查，同时将介入放射学和/或手术干预保留用于难治性或危及生命的紧急情况。
