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Abstract
Biliary hemorrhage may occur in a variety of clinical settings, but spontaneous hemobilia
has not been reported from a cirrhotic liver. We describe a case of major hepatic
hemobilia in a patient with cirrhosis and no history of trauma. A 50-year-old woman
had abdominal pain, melena, and profound anemia. An extensive workup did not show
the site of bleeding but did show a mass in the gallbladder. Cholecystectomy was performed,
and at operation the patient was found to have cirrhosis and portal hypertension.
The gallbladder “mass” was simply an organized clot, and hemorrhage recurred postoperatively.
On reoperation, bleeding from the ampulla of Vater was observed, confirming the diagnosis
of hemobilia. She was treated with angiographic interruption of hepatic arterial flow,
at which time bleeding ceased. Her total transfusion requirements included 46 units
of blood. Through 16 months of follow-up the patient has had no recurrent bleeding
and no evidence of encephalopathy. This case demonstrates that spontaneous hemobilia
may indeed arise from a cirrhotic liver. Proximal interruption of arterial flow is
usually not recommended for hemobilia, especially in the presence of portal hypertension
and cirrhosis, but may be life-saving in selected patients.
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Article info
Publication history
Accepted:
November 17,
1988
Footnotes
☆Presented at the Fortieth Annual Meeting of the South-western Surgical Congress, Phoenix, Ariz., April 10–13, 1988.
Identification
Copyright
© 1989 Published by Elsevier Inc.
