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A severe case of hemobilia and biliary fistula following an open urgent cholecystectomy

DOI: 10.1186/1749-7922-4-37

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We report here a case of massive hemobilia in a 60-year-old man who underwent an urgent open cholecystectomy and a subsequent placement of a transhepatic biliary drainage.The management of these complications enclose endoscopic, percutaneous and surgical therapies. After a diagnosis of biliary fistula, it's most important to assess the adequacy of bile drainage to determine a controlled fistula and to avoid bile collection and peritonitis. Transarterial embolization is the first line of intervention to stop hemobilia while surgical intervention should be considered if embolization fails or is contraindicated.Percutaneous transhepatic biliary drainage (PTHBD) is one of the most therapeutic options for the menagement of biliary obstructive disorders, but the use of interventional procedures is associated with an increased incidence of arteriovenous shunting, hepatic artery pseudoaneurysm and vascular stenoses that result in hemobilia[1].The diagnosis of hemobilia may be difficult because of a variety of clinical manifestations and sometimes can be fatal. Its management aims to stopping the bleeding and resolve obstruction. Actually the development of interventional radiology, such as transarterial embolization, has been recognized the first line of procedure to stop hemobilia with a success rate of about 80%-100%, by ensuring that the classic surgery interventions, such as ligation of bleeding vessels or excisions of aneurysms, should be considered fails and burdened by high mortality [2,3].A 60-year-old man came to our observation with intermittent pain localized to upper quadrants of the abdomen, fever (39°C) preceded by thrill, vomiting and signs of peritoneal interesting. Laboratory tests revealed leucocytosis (18300 WBC), and the increment of cholestasis markers, while US scan demonstred an acute cholecystitis with lithiasis, without biliary tree dilatation, and a small liquid flap next to gallbladder.Because of poor conditions, we decided to perform a surgical o

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