Hemobilija

The phenomenon now known as haemobilia was first recorded in XVII century by well known anatomist from Cambridge, Francis Glisson and his description was published in Anatomia Hepatis in 1654. Until today etiology, clinical presentation and management are clearly defined. Haemobilia is a rare clinical condition that has to be considered in differential diagnosis of upper gastrointestinal bleeding. In Western countries, the leading cause of haemobilia is hepatic trauma with bleeding from an intrahepatic branch of the hepatic artery into a biliary duct (mostly iatrogenic in origin, e.g. needle biopsy of the liver or percutaneous cholangiography). Less common causes include hepatic neoplasm; rupture of a hepatic artery aneurysm, hepatic abscess, choledocholithiasis and in the Orient, additional causes include ductal parasitism by Ascaris lumbricoides and Oriental cholangiohepatitis. Clinical presentation of heamobilia includes one symptom and two signs (Quinke triad): a. upper abdominal pain, b. upper gastrointestinal bleeding and c. jaundice. The complications of haemobilia are uncommon and include pancreatitis, cholecystitis and cholangitis. Investigation of haemobilia depends on clinical presentation. For patients with upper gastrointestinal bleeding oesophagogastroduodenoscopy is the first investigation choice. The presence of blood clot at the papilla of Vater clearly indicates the bleeding from biliary tree. Other investigations include CT and angiography. The management of haemobilia isdirected at stopping bleeding and relieving biliary obstruction. Today, transarterial embolization is the golden standard in the management of heamobilia and if it fails further management is surgical. Prvi opis fenomena koji danas nazivamo hemobilijom potice iz 17. veka i opisao ga je poznati anatom iz Kembridza Francis Glisson u knjizi "Anatomia Hepatis" 1654 godine. Sve do 1948. godine opisivani su slucajevi hemobilije medjutim sam termin "hemobilija" jos nije bio u upotrebi. Od tada do danas utvrdjena je etiologija, opisana je klinicka manifestacija hemobilije i modalitet lecenja. Do danas hemobilija ostaje retko klinicko stanje koje se teze prepoznaje ali mora biti deo diferencijalne dijagnoze gastrointenstinalnog krvarenja. U zemljama zapadne Evrope i Amerike glavni uzrok hemobilije je povreda jetre sa krvarenjem iz intrahepaticnog segmenta hepaticne arterije u bilijarno stablo (najcesce jatrogena trauma tokom biopsije jetre ili pri perkutanoj holangiografiji). Red