Korean J Gastroenterol.  2013 Jan;61(1):46-49. 10.4166/kjg.2013.61.1.46.

Massive Bleeding Hemobilia Occurred in Patient with Hepatocellular Carcinoma

Affiliations
  • 1Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea. cwkim@catholic.ac.kr

Abstract

Massive bleeding hemobilia occurs rarely in patients with hepatocellular carcinoma (HCC) without any invasive procedure. Upper gastrointestinal bleeding in patient with cirrhosis and abdominal pain with progressive jaundice in patient with HCC were usually thought as variceal bleeding and HCC progression respectively. We experienced recently massive bleeding hemobilia in patient with HCC who was a 73-year old man and showed sudden abdominal pain, jaundice and hematochezia. He had alcoholic cirrhosis and history of variceal bleeding. One year ago, he was diagnosed as HCC and treated with transarterial chemoembolization periodically. Sudden right upper abdominal pain occurred then subsided with onset of hemotochezia. Computed tomography showed bile duct thrombosis spreading in the intrahepatic and extrahepatic ducts, while an ampulla of vater bleeding was observed during duodenoscopy. Hemobilia could be one of the causes of massive bleeding in patients with cirrhosis and HCC especially when they had sudden abdominal pain and abrupt elevation of bilirubin.

Keyword

Hemobilia; Carcinoma, hepatocellular; Gastrointestinal hemorrhage; Cholestasis

MeSH Terms

Aged
Bile Ducts, Extrahepatic
Bile Ducts, Intrahepatic
Bilirubin/analysis
Carcinoma, Hepatocellular/complications/*diagnosis/therapy
Duodenoscopy
Embolization, Therapeutic
Hemobilia/*etiology
Humans
Jaundice/etiology
Liver Cirrhosis/complications
Liver Neoplasms/complications/*diagnosis/therapy
Male
Severity of Illness Index
Thrombosis/diagnosis
Tomography, X-Ray Computed
Bilirubin

Figure

  • Fig. 1. Abdominal CT scan showed intrahepatic and extrahepatic bile duct thrombosis in the patients with hepatocellular carcinoma and cirrhosis. (A) Contrast enhanced axial CT scans showed the dilated intrahepatic bile duct filled with intraluminal hyperattenuated material, bile duct thrombus (arrows). (B) Contrast enhanced coronal CT scans showed the dilated extahepatic bile duct filled with intraluminal hyperattenuated materials, bile duct thrombus (arrows). (C) Contrast enhanced axial CT scan during arterial phase showed multiple arterial enhancing nodules near the bile duct (arrows).

  • Fig. 2. Bleeding from ampulla of Vater was observed during duodenoscopy.


Reference

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