Bilhemia occurs when a fistula is created between a bile duct and a vein within the liver, letting bile get into the systemic circulation.
Presentation:
(1) recent history of hepatic trauma
(2) rapid increase in total, direct and indirect serum bilirubin
(3) marked increase in bile acids within the serum
(4) absence of comparable change in serum transaminases accompanying the hyperbilirubinemia
The fistula can be demonstrated by ERCP with retrograde cholangiography.
Sometimes the fistula will close on its own. Therapy may involve resecting the fistula, T-tube drainage of the common bile duct (which reduces the pressure in the biliary system) or using interventional radiology to block the fistula.
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