Hemobilia: A Fatal Cause of Obscure Gastrointestinal Bleeding Diagnosed by Abdominal Computed Tomography

Abstract

Hemobilia is characterized by hemorrhage into the biliary system and is an unusual cause of obscure gastrointestinal bleeding. At endoscopy, active bleeding or blood clots can be observed at the papilla of Vater, but diagnosis can be difficult if the hemorrhage has ceased. Here, we report a 67-year-old man who was admitted to our emergency department for evaluation of obscure gastrointestinal bleeding. He had been admitted to another hospital for obscure gastrointestinal hemorrhage three times during the previous month. Repeat endoscopic examinations were inconclusive. Emergency abdominal CT disclosed active contrast extravasations from the gallbladder with blood clots in the common bile duct. A diagnosis of hemobilia was made. The patient rapidly developed hypovolemic shock and died 12 hours after admission. This case illustrated that abdominal CT may be useful for diagnosis of obscure gastrointestinal bleeding in an emergency setting. Clinicians should be reminded that hemobilia is a possible cause of bleeding when jaundice and abdominal pain are associated with gastrointestinal bleeding.