Last revised by Hamish Smith on 9 May 2018

Hemobilia refers to the presence of blood in the biliary tree.

The classical clinical triad, only seen in ~50% of cases, consists of:

  1. melena (i.e. upper gastrointestinal bleeding)
  2. jaundice
  3. abdominal pain
  • iatrogenic: surgical or percutaneous procedures (~67%)
  • trauma (~5%)
  • vascular malformations (7%)
    • e.g. hepatic artery aneurysm or arteriovenous malformation
    • can cause massive hemobilia
  • malignancy (e.g. hepatocellular carcinoma - most common, gallbladder metastases)
  • abscess formation
  • gastrointestinal bleed due to gallstones

Ultrasound is often the first investigation and reveals echogenic material in the bile ducts and dilated gallbladder.

  • high-attenuation clot within the bile ducts

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Cases and figures

  • Case 1
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  • Case 2: post biopsy
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