Endovascular Management of Hemobilia as a Complication of Percutaneous Biliary Drainage

Hemobilia is an uncommon but potentially life-threatening cause of upper gastrointestinal bleeding, resulting from an abnormal communication between the biliary tract and adjacent vascular structures. In contemporary practice, iatrogenic injury has become the leading cause of hemobilia, particularly in the setting of invasive hepatobiliary procedures. Among these, percutaneous transhepatic biliary drainage is a well-recognized but infrequent source of vascular complications. We report the case of a 74-year-old female patient with obstructive jaundice secondary to a hilar tumoral lesion who underwent percutaneous transhepatic biliary drainage. Approximately 36 hours after the procedure, she developed clinically significant hemobilia with hemodynamic compromise, manifested by active bleeding through the biliary drainage catheter and acute anemia requiring transfusion of two units of packed red blood cells. Cholangiography demonstrated a dilated biliary tree with intraductal filling defects consistent with blood clots. Subsequent selective hepatic arteriography revealed a hepatic arterial pseudoaneurysm with active contrast extravasation into a biliary radicle. The lesion was successfully treated with selective transarterial endovascular embolization, achieving complete exclusion of the pseudoaneurysm and resolution of the bleeding. This case highlights the pathophysiological mechanisms of iatrogenic hemobilia following biliary interventions and underscores the importance of early recognition. It also emphasizes the pivotal role of angiography and transarterial embolization as first-line diagnostic and therapeutic tools in the management of this potentially severe complication.