Bleeding Bile (Hemobilia): An Obscure Cause of Upper Gastrointestinal Bleeding: Case Report and Review of the Literature

We report the case of a 76-year-old male who developed acute upper gastrointestinal bleeding (UGIB) and obstructive jaundice secondary to one of the rarer causes of UGIB, hemobilia (bleeding into the biliary tree). Bleeding was due to pseudoaneurysm of right hepatic artery after placement of right and left hepatic duct stents. An emergent hepatic angiogram with embolization was performed with successful hemostasis. Common causes of hemobilia are iatrogenic, trauma, gallstones, inflammation/ infection, vascular disorders and neoplasm. The classic hemobilia triad includes bleeding (melena 90%, hematemesis 60%), biliary colic (70%) and obstructive jaundice (60%). Angiography is the definitive diagnostic and therapeutic procedure with a success rate of over 90%. In our patient, angiographic embolization provided only temporary reversal of his condition because stents continued to erode into the hepatic arteries. We present this case to remind clinicians that hemobilia is a possible cause of UGIB, especially in patients who present with jaundice, and in patients with biliary stents it can be fatal.