Objective To investigate the diagnosis, treatment, and prevention of hemobilia from ruptured false aneurysms after hepatobiliary surgery.Methods A retrospective analysis was performed on the clinical data of 14 patients with hemobilia from ruptured false aneurysms after hepatobiliary surgery who were admitted to Department of Hepatobiliary Surgery, Chinese PLA General Hospital from January 2002 to March 2012.These patients were divided into three groups to receive conservative treatment, exploratory laparotomy and hemostasis (done immediately after hemobilia) , or selective digital subtraction angiography (DSA) and transhepatic arterial embolization (TAE) (done immediately after hemobilia) .The key points of diagnosis and treatment and preventive measures were investigated.Results Of the 14 patients, 6 died, and 8 were cured.Conservative treatment was performed in 2 patients, but failed in both of them (100%) ;then, the 2 cases underwent DSA and received TAE, and one of them died.Five patients received exploratory laparotomy and hemostasis;2 cases (40%) were cured after confirmed diagnosis, and the other 3 cases then underwent DSA and received TAE after operation, with one dead.Three patients received selective DSA and TAE immediately after hemobilia;all the 3 cases (100%) had a confirmed diagnosis and were cured.Selective DSA was performed in 8 patients, and all (100%) of them had a confirmed diagnosis.TAE was done 9 times in 8 patients, and 8 times (89%) of TAE were effective;6 cases (75%) were cured, 1 case received TAE twice, and 2 cases died after TAE.Of all the dead cases, 4 suffered sudden death, 1 died of liver failure after 2 times TAE, and 1 died of multiple organ failure after laparotomy and TAE.Conclusion Early diagnosis and treatment are essential for hemobilia from ruptured false aneurysms after hepatobiliary surgery;selective DSA is the optimal diagnostic method, and TAE should be the first choice of treatment.The formation of false aneurysms after hepatobiliary surgery is related to surgical operation, and more attention should be directed to prevention.
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