Our purpose here is to describe our experience with important
hemobilia following
PTBD and to determine whether left-sided percutaneous transhepatic biliary drainage (
PTBD) is associated with an increased incidence of important
hemobilia compared to right-sided drainages. We reviewed 346 transhepatic biliary drainages over a four-year period and identified eight patients (2.3%) with important
hemobilia requiring transcatheter embolization. The charts and radiographic files of these patients were reviewed. The side of the
PTBD (left versus right), and the order of the biliary ductal branch entered (first, second, or third) were recorded. Of the 346 PTBDs, 269 were right-sided and 77 were left-sided. Of the eight cases of important
hemobilia requiring transcatheter embolization, four followed right-sided and four followed left-sided
PTBD, corresponding to a
bleeding incidence of 1.5% (4/269) for right
PTBD and 5.2% (4/77) for left
PTBD. The higher incidence of
hemobilia associated with left-sided
PTBD approached, but did not reach the threshold of statistical significance (p = 0.077). In six of the eight patients requiring transcatheter embolization, first or second order biliary branches were accessed by
catheter for
PTBD. All patients with left-sided
bleeding had first or proximal second order branches accessed by biliary drainage
catheters. In conclusion, a higher incidence of
hemobilia followed left-versus right-sided
PTBD in this study, but the increased incidence did not reach statistical significance.