Hemobilia is not uncommon following PTBD. It is particularly true in cases where the confluence is non-patent and excessive manipulation is required during the procedure. Hemobilia secondary to venous and arterial injury has a clear protocol of management that is well discussed in literature. However, there is paucity of data in general on management of hemobilia not related to vascular injury. Should we clamp the catheter if there is hemobilia in an attempt to create a tamponade effect? My experience is that lesser the manipulation, lesser the chances of hemobilia. However, much needs to be learnt about this distressing complication.
In case of hemobilia after PTBD, not related to vascular injury do first lavage and aspiration of the PTBD with saline solution to remove major blood clots to prevent tamponade/occlusion of drainage or biliary ducts. Give the patient UDC (ursodesoxycholacid) 250 mg 2-2-2 to have an increase of biliary secretion and to have thinner and more liquid bile resulting in an endogeneous lavage of the biliary system. No clamping of the catheter, allow external drainage. Monitoring of the patient is needed. Mostly after 24 to 48 hrs you will have clear bile secretion over the drainage.
Thanks Dear Alexander for your valuable suggestions. How frequently do you face this complication. Actually what we practice now is clamping of the PTBD catheter.
Can I get some references please, suggesting the management of this problem
Best Regards
I THINK REPEATED LAVAGE WITH HEPARINIZED SALINE IS ENOUGH SUGGESTING THAT THERE IS NO VASCULAR INJURY OR COAGULOPATHY ....WITH REPEATED LAVAGE THERE WILL BE NO RETAINED CLOTS THAT MAY BLOCK EXTERNAL DRAINAGE...MY MIND IS THAT URSODEOXYCHOLIC ACID IS OF NO BENEFIT IN SUCH CASES
I'm not in a specialized center in minimally invasive. So we do to clamp the catheter and control hemodynamics.
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