Hemobilia : Four Case Reports and Review of the Literature

DUANGPORN THONG-NGAM, M.D.*, VIBHAKORN SHUSANG, M.D.**, PONGSIT WONGKUSOLTHAM, M.D.**, LINDA BROWN, M.D.***, PINIT KULLA V ANUAYA, MB ChB, DTM&H, FRCP.**

Affiliation : * Department of Physiology, **Department of Medicine, Gastroenterology Unit, ***Department of Radiology, Faculty of Medicine, Chulalongkom University, Bangkok 10330, Thailand.

AbstractIn this report, we present four cases of hemobilia. Hemobilia occurs when conditions produce an abnormal communication between blood vessels and bile ducts. Although iatrogenic procedures as causes of hemobilia have been reported with increasing frequency, non-iatrogenic etiologies are still quite rare. We, therefore, report 4 cases of hemobilia secondary to different etiologies found in our institution from 1996 to 1998, that are non-iatrogenic. The first patient was a case of congenital aneurysm, the second pseudoaneurysm from trauma, the third cholangio carcinoma and the fourth hepatocellular carcinoma. The classical triad consists of melena, jaundice and abdominal pain. Direct observation of blood flowing from the Ampulla of Vater by endos copy was the initial diagnostic procedure in all four cases. Diagnosis was confirmed by ultra sonography, computerized tomography, angiography or surgery. Transcatheter selective emboli zation as a noninvasive treatment for hepatic aneurysm I pseudoaneurysm is emphasized.

Keywords : Hemobilia

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