Abstract
Background
Hemobilia refers to bleeding in the biliary tract, commonly due to iatrogenic, traumatic,
and neoplastic causes. It is a rare source of upper gastrointestinal hemorrhage, but
it can be severe and fatal. However, gallstones account for 5%–15% of hemobilia cases.
Case Report
A 60-year-old woman with diabetes mellitus and chronic kidney disease visited the
emergency department with complaints of epigastric pain and vomiting of coffee ground–like
content for 2 days. Physical examination revealed epigastric tenderness and hyperactive
bowel sounds. Laboratory tests showed anemia with a hemoglobin count of 10.7 mg/dL
and elevated liver function tests with total and direct bilirubin levels of 3.6 mg/dL
and 2.5 mg/dL, respectively. Panendoscopy showed oozing of coffee ground–like material
at the orifice of the ampulla of Vater and second portion of the duodenum, leading
to suspicion of hemobilia. After admission, endoscopic retrograde cholangiopancreatography
revealed common bile duct (CBD) dilatation with choledocholithiasis, biliary sludge,
and filling defect at the middle section of the CBD. Endoscopic sphincterotomy with
balloon lithotripsy was performed. After biliary decompression and broad-spectrum
antibiotic administration, abdominal pain was relieved, and liver enzyme and total
bilirubin levels improved. Symptoms of hemobilia depend on the bleeding rate and presence
of bile duct obstructions due to clots. Minor and slow bleeding tend to form clots
and cause biliary obstruction.
Why Should an Emergency Physician Be Aware of This?
Although minor hemobilia may remain asymptomatic and tends to resolve spontaneously,
the cause of hemobilia must be corrected to prevent recurrent bleeding or obstruction.
Keywords
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References
- Hemobilia: etiology, diagnosis, and treatment.Liver Res. 2018; 2: 200-208
- Hemobilia: an uncommon but notable cause of upper gastrointestinal bleeding.J Clin Gastroenterol. 2017; 51: 796-804
- Etiology, clinical features, and endoscopic management of hemobilia: a retrospective analysis of 37 cases.Korean J Gastroenterol. 2012; 59: 296-302
- Minor hemobilia. Clinical significance and pathophysiological background.Ann Surg. 1979; 190: 254-264
- The clinical significance of bile duct sludge: is it different from bile duct stones?.Surg Endosc. 2007; 21: 769-773
- Unusual complications of gallstones.Surg Clin N Am. 2014; 94: 377-394
- Common bile duct blood clot: an unusual cause of ductal filling defects for calculi.J Gastroenterol. 1999; 34: 420-423
Article info
Publication history
Published online: April 27, 2020
Accepted:
March 18,
2020
Received in revised form:
February 6,
2020
Received:
December 3,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
