HÉMOBILIE APRÈS TRAUMATISME HÉPATIQUE FERMÉ : INTÉRÊT DE L’ARTÉRIOGRAPHIE ET DE L’EMBOLISATION

Introduction : The hemobilia is the result of a pathological communication between bile ducts and vesseles the intra or extra hepatic. Observation : We reported a case of a 48 year old patient who was admited to emergency service for an accident of the public highway with a central hepatic-hematome, detected by scanner. The treatment consisted of a simple monitoring. Three weeks after the hepatic contusion, the patient developed a hemobilia by cracking of intra hepatic a pseudoaneurism in the bile ducts, the diagnosis had been evoked by the presence of hematemess, directed by Doppler echo, and confirmed by the coeliace arteriography. The haemostasis was successfully treated by precutneous arteriographic embolisation. Without recurence for two years. Discussion : The post traumatic hemobilia is a rare complication of the hepatic contusions, observed in 0,5 to 2 % of the cases. Traditional symptomatology gathers three signs or triad of Sandbloom, which biliary colics, ictere and digestive haemorrhage. Pulsated the Doppler echo is an effective examination in the tracking of the hepatic aneurisms. The surgery which was formerly the treatment of choice of the hemobilies currently left place to the percutaneous embolisation.