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Hemobilia: Massive hemorrhage from the common bile duct due to a T tube

1960; Elsevier BV; Volume: 100; Issue: 4 Linguagem: Inglês

10.1016/0002-9610(60)90336-6

1879-1883

Peter Hutchin, E. P. Smith,

Biliary and Gastrointestinal Fistulas

A rare cause of hemobilia may be mechanical erosion of the common bile duct due to an indwelling T tube. The etiologic basis for the bleeding in most cases is the intimate relation of the distal common duct to the posterior superior pancreaticoduodenal artery and the prepancreatic arterial arcade. The role of ascending cholangitis remains uncertain but may be an important predisposing factor in the development of hemorrhage. Nine cases of massive intracholedochal hemorrhage were collected from the literature and a tenth case is added. The mortality of the reported cases has been 50 per cent. The most rational treatment of the bleeding episode appears to be transfusion of whole blood and in nonresponsive cases laparotomy with ligation of the bleeding vessel. Antibiotics should be used if there is evidence of ascending cholangitis. By way of prevention, intubation of the common duct should be avoided unless a definite indication is present.