Hemobilia, a rare cause of upper gastrointestinal bleeding

Abstract

Hemobilia is a rare cause of upper gastrointestinal (GI) tract bleeding. Its main etiology is iatrogenic, and
the possibility of hemobilia should be considered in any patient with GI bleeding and a recent history of
hepatobiliary surgery. Other less frequent causes include abdominal trauma, oncologic disease of the biliary
tract, or inflammatory diseases of the pancreas or bile duct. Its clinical presentation varies depending on the
severity of the bleeding. It usually presents with abdominal pain, jaundice, and tarry stools, although patients
may also present with rectorrhagia and hypotension on admission. A high percentage of these symptoms
have a spontaneous resolution, without requiring additional procedures. Angiography is the gold standard for the diagnosis of hemobilia, but advances in computed tomography angiography make it a less invasive and more widely available option. Endovascular embolization is the main treatment for these patients, but there are other alternatives such as vascular or bile duct stent placement.