The choice of subsequent investigations depends on the history and the level of suspicion. Abdominal

sonography or computed tomography can detect common bile duct obstruction and buy Momelotinib identify intrahepatic lesions, such as stones or tumors. Endoscopic retrograde cholangiopancreatography may be helpful. Angiography could detect significant hemobilia in over 90% of patients, and allow the localization of vascular lesions and therapeutic embolization. The management of hemobilia is, in fact, aimed at stopping the bleeding and relieving biliary obstruction, especially when the condition of patient is so severe that a fast treatment is required. Transarterial embolization is now the first line of intervention to stop the bleeding of hemobilia, which returned a high success rate of around 80% to 100% [1], and lower morbidity or mortality rates than surgery. Surgical interventions, such as ligation of the bleeding vessel or excision of the aneurysm, should be considered if embolization fails or is contraindicated. Transcatheter embolization has several

advantages over surgical approaches: (a) it can be combined with angiography and also repeated, (b) it is safer because it deals directly with the arterial lesion, and (c) it is better tolerated by debilitated patients who show major surgical risks. Treatment of these vascular lesions varies depending on the size of damaged vessels and on the characteristics of the lesions [15]. In general transcatheter embolization of distal intrahepatic

vascular lesions is successfully Go6983 manufacturer best performed using micro-particles of a variety of materials (coil, gelatine sponge, polyvinyl alcohol, etc.) [16]. In case the pseudoaneurysm Tobramycin is located at the level of large hepatic vessels, the placement of a covered stent may be a valid therapeutic alternative, as we made in the case above [17–20]. On the basis of our experience, in iatrogenic hepatic bleeding, therapeutic interventional procedures represent the treatment of choice as they enable diagnosis and treatment in a single session and, especially in the case of Sirolimus solubility dmso intra-hepatic bleeding, they avoid complex surgical procedures in patients who are often haemodynamically unstable and therefore at high anaesthetic and surgical risk. Consent Section Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copyof the written consent is available for review by the Editor-in-Chief of this journal References 1. Thong-Ngam D, Shusang V, Wongkusoltham P, Brown L, Kullavanijaya P: Hemobilia: four case reports and review of the literature. J Med Assoc Thai 2001,84(3):438–44.PubMed 2. Moodley J, Singh B, Lalloo S, Pershad S, Robbs JV: Non-operative management of haemobilia. Br J Surg 2001,88(8):1073–6.CrossRefPubMed 3.