Haemobilia after blunt hepatic traumatism: interest of the arteriography and the embolisation

ABSTRACT

The hemobilia is the result of a pathological communication between bile ducts and vessels the intra or extra hepatic. We reported a case of a 48 year old patient who was admitted to emergency service for an accident of the public highway with a central hepatic-hematome, detected by scanner. The treatment consisted of a simple monitoring. Three weeks after the hepatic contusion, the patient developed a hemobilia by cracking of intra hepatic a pseudoaneurism in the bile ducts, the diagnosis had been evoked by the presence of hematemess, directed by Doppler echo, and confirmed by the coeliace arteriography. The haemostasis was successfully treated by precutneous arteriographic embolisation. Without recurrence for two years. The post traumatic hemobilia is a rare complication of the hepatic contusions, observed in 0.5 to 2 percent of the cases. Traditional symptomatology gathers three signs or triad of Sandbloom, which biliary colics, ictere and diagestive haemorrhage. Pulsated the Doppler echo is an effective examination in the tracking of the hepatic aneurisms. The surgery which was formerly the treatment of choice of the hemobilies currently left place to the percutaneous embolisation