Table 1 Causes of hemobilia stratified by pathophysiology
From: Hemobilia caused by a ruptured hepatic cyst: a case report
Pathophysiology | Various causes of hemobilia |
|---|---|
Iatrogenic trauma (most common cause) | Most common causes: needle biopsy of liver, percutaneous biliary drainage |
| Â | Sphincterotomy, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiogram (PTC) |
| Â | Biliary stent trauma, cholecystectomy, choledochoscopy (spyglass) |
Trauma | Blunt trauma more common than penetrating trauma |
Inflammation | Gallstone disease and cholangitis (most common in this category) |
| Â | Acalculous cholecystitis, polyarteritis nodosa |
| Â | Tropical hemobilia (ductal parasitism caused by Ascaris lumbricoides) |
Hepatic polyp or neoplasm | Benign lesions such as benign adenomatous polyp, diffuse papillomatosis |
| Â | Gall bladder polyp |
| Â | Malignant neoplasms such as hepatocellular carcinoma, cholangiocarcinoma; metastasis |
Spontaneous hemobilia | From pathological coagulopathy or therapeutic coagulopathy |
Aneurysms | Ruptured hepatic artery aneurysm (most common in this category) |
| Â | Cystic artery pseudoaneurysm |
| Â | Post-traumatic pseudoaneurysm of an anomalous right hepatic artery with arterio-biliary fistula (rare case report) |
Hepatic cystic lesions | Hepatic abscess or hepatic cyst (hemobilia complicating liver abscess and/or cyst) |
Miscellaneous (rare) | Potentially fatal hemobilia due to inappropriate use of an expanding biliary stent, pancreatic pseudocyst |
| Â | Arterio-choledochal fistula, erosion of hepatic artery by cholelithiasis with cholecystoduodenal fistula |