Massive Bleeding Hemobilia Occurred in Patient with Hepatocellular Carcinoma

Kyung Eun Lee; Chang Wook Kim; Min Ju Kim; Jinhee Park; Gu Min Cho; Jeong Won Jang; Young Sok Lee; Chang Don Lee

doi:10.4166/kjg.2013.61.1.46

Journal List > Korean J Gastroenterol > v.61(1) > 1007109

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Lee, Kim, Kim, Park, Cho, Jang, Lee, and Lee: Massive Bleeding Hemobilia Occurred in Patient with Hepatocellular Carcinoma

Case Report

Korean J Gastroenterol 2013;61(1):46-49.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.61.1.46

Massive Bleeding Hemobilia Occurred in Patient with Hepatocellular Carcinoma

Kyung Eun Lee, Chang Wook Kim, Min Ju Kim, Jinhee Park, Gu Min Cho, Jeong Won Jang, Young Sok Lee, Chang Don Lee

Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea

Correspondence to: Chang Wook Kim, Department of Internal Medicine, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, 271 Cheonbo-ro, Uijeongbu 480-717, Korea. Tel: +82-31-820-3997, Fax: +82-31-847-2719, E-mail: cwkim@catholic.ac.kr

Received 2 February 201216 April 2012 Accepted 19 April 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Hemobilia, Carcinoma, hepatocellular, Gastrointestinal hemorrhage, Cholestasis

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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.

Table 1.

Clinical and Radiologic Manifestations of the Patients with HCC and Massive Bleeding Hemobilia

Author, Year	Age (yr)/Gender	Presentation symptom and sign			BDT in CT scan	Treatment
Author, Year	Age (yr)/Gender	Abdominal pain	Jaundice	Melena or hematemesis	BDT in CT scan	Treatment
Contractor et al., 1997¹¹	66/M	＋	＋	＋	Yes	Conservative
Kitagawa et al., 1999¹⁵	56/M	＋	＋	＋	Yes	TAE
	55/M	＋	＋	＋	Yes	TAE
	70/F	＋	＋	＋	Yes	TAE
Shibata et al., 2003¹⁶	67/M	＋	−	＋	Yes	TAE
	77/M	−	＋	＋	Yes	TAE
	55/M	−	＋	＋	Yes	TAE
	58/M	−	＋	＋	Yes	TAE
Takao et al., 2008¹⁷	70/M	＋	＋	＋	Yes	TAE followed by MCT

HCC, hepatocellular carcinoma; BDT, bile duct thrombi; TAE, transcatheter hepatic arterial embolization; MCT, microwave coagulation treatment; M, male; F, female.

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