Multidisciplinary approach to the diagnosis and treatment of hemobilia (Clinical case)

Abstract

Today, thanks to the development and implementation of new modern instrumental research methods in the daily practice of doctors, such as computed tomography with angiography, multispiral computed tomography, ultrasound examination of vessels with duplex scanning, celiacography, upper and lower mesentericography, etc. Every year, the information content of the above examination methods is growing, which will certainly lead to an increase in the frequency of detecting rare vascular pathologies that cause hemobilia. The method of treatment for this vascular pathology is endovascular embolization using embolizing coils and substances. A clinical case of a multidisciplinary approach to diagnosis and endovascular treatment is presented. a. gastroduodenalis with the formation of a pseudo-aneurysm (40 × 20 mm) with antegrade blood flow along a.pancreaticoduodenalis superior and a.gastroepiploica dextra distal to the aneurysm of a 28-year-old patient who was urgently hospitalized in the surgical department of Kyiv Regional Clinical Hospital. After the surgical treatment against the background of conservative treatment, the patient’s general condition improved and the hemoglobin level increased. A multidisciplinary approach helps to choose the right tactics for managing a patient, even with such a rare vascular pathology that has led to hemobilia. The gold standard for diagnosis and treatment hemobilia is angiography and endovascular embolization, which can be an alternative to open surgery, minimizes the risk of postoperative complications and reduces the rehabilitation period. If it is impossible to carry out the above technique or its ineffectiveness, further treatment is surgical.

Keywords

• hemobilia; video gastroduodenoscopy; celiacography; transarterial embolization.