Bilhaemia

Extremely rare condition in which bile flows into the bloodstream through the hepatic veins or portal vein branches

Pathophysiology

• Caused by high intra-biliary pressure exceeding that of the venous system
• Can be caused by gallstones eroding into the portal vein or accidental or iatrogenic trauma
• Usually low-flow, and fistulas close spontaneously

Presentation

• Rapidly increasing jaundice
• Marked direct hyper-bilirubinaemia without elevation of hepatocellular enzyme levels
• Septicaemia

Complications

• Embolisation of large amounts of bile to lungs - potentially fatal

Diagnosis

• ERCP

Treatment

• Lower intra-biliary pressures via sphincterotomy or stents