Life-threatening hemobilia caused by hepatic artery pseudoaneurysm: A rare complication of chronic cholangitis

Hemobilia is one of the causes of obscure gastrointestinal haemorrhage. Most cases of hemobilia are of iatrogenic or traumatic origin. Hemobilia caused by a hepatic artery pseudoaneurysm due to ascending cholangitis is very rare and its mechanism is undear. We report a 74-year-old woman with a history of surgery for choledocholithiasis 30 years ago, suffering from a protracted course of life-threatening gastrointestinal bleeding. A small intestines series and endoscopic retrograde cholangiopancreatography revealed a chronic cholangitis with marked contrast reflux into the biliary tree. Angiography confirmed the bleeding from a pseudoaneurysm of the middle hepatic artery. Coil embolization achieved successful hemostasis. We discussed the mechanism and reviewed the literature.

Hemobilia is one of the causes of obscure gastrointestinal haemorrhage.Most cases of hemobilia are of iatrogenic or traumatic origin.Hemobilia caused by a hepatic artery pseudoaneurysm due to ascending cholangitis is very rare and its mechanism is unclear.We report a 74-year-old woman with a history of surgery for choledocholithiasis 30 years ago,suffering from a protracted course of life-threatening gastrointestinal bleeding.A small intestines series and endoscopic retrograde cholangiopancreatography revealed a chronic cholangitis with marked contrast reflux into the biliary tree.Angiography confirmed the bleeding from a pseudoaneurysm of the middle hepatic artery.Coil embolization achieved successful hemostasis.We discussed the mechanism and reviewed the literature.