Background: Hemobilia is defined as hemorrhage into the biliary tract. With frequent use of invasive hepatobiliary procedures in current gastroenterology practice and promptly advancing imaging and endoscopic techniques, this disease process is increasingly being diagnosed. Clinically, this condition often presents as a classic triad of biliary colic, jaundice and upper gastrointestinal bleed (manifesting as hematemesis or melena). Case Report: A 35-year-old white woman with recent liver biopsy presented to the emergency department with 1 week’s history of right upper quadrant abdominal pain, nausea, vomiting, and multiple episodes of bleeding per rectum. X-ray abdomen and CT scan were unremarkable. Esophagogastroduodenoscopy was performed which showed ongoing blood flow through the ampulla of Vater. Diagnosis of hemobilia was made. Angiographic embolization of the segmental hepatic artery was done with resolution of bleeding. Conclusion: To conclude, hemobilia is a rare cause of upper gastrointestinal bleed. Trauma, predominantly iatrogenic and occasionally accidental, is the most common cause for this disease entity. Bleeding in these cases manifests predominantly as hematemesis or melena. In rare cases, as in our patient, bleeding may present as hematochezia. Diagnosis is predominantly made on upper gastrointestinal endoscopy. Angiographic embolization remains the cornerstone of management.

Keywords:
Hemobilia, Liver biopsy, Hematochezia
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© 2008 S. Karger AG, Basel
2008
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