Korean J Gastroenterol.  2010 Sep;56(3):205-208. 10.4166/kjg.2010.56.3.205.

Hemobilia as the Initial Manifestation of Cholangiocarcinoma in a Patient with Choledochoduodenostomy

• Ryu DY
• Cheong JH
• Lee DG
• Lee BE
• Kim DU
• Kim GH
• Song GA

• KMID: 948784
• DOI: http://doi.org/10.4166/kjg.2010.56.3.205

Abstract

Hemobilia occurs when injury or disease causes communication between intrahepatic blood vessels and the intrahepatic or extrahepatic biliary system. The causes of hemobilia include trauma, gallstone disease, vascular malformation, inflammation, and biliary or hepatic tumors. Hemobilia could be diagnosed by endoscopy, hepatic angiography, computed tomography, and ultrasonogram. Patients with hemobilia may present with biliary colic, obstructive jaundice and gastrointestinal bleeding. Extrahepatic cholangiocarcinoma usually presents with obstructive jaundice and is one of the unusual cause of hemobilia. We, herein, report a case of hemobilia caused by cholangiocarcinoma in a 69-year-old woman. She had the past history of lung cancer and choledochoduodenostomy due to gallstone. Esophagogastroduodenoscopy revealed a blood clot protruding from the choledochoduodenostomy site and the ulcerative mass in the common bile duct. Pathologic examination of the ulcerative mass was compatible with those of cholangiocarcinoma.

Keyword

Hemobilia; Cholangiocarcinoma; Choledochoduodenostomy

MeSH Terms

Aged
Bile Duct Neoplasms/*diagnosis/pathology
*Bile Ducts, Intrahepatic
Cholangiocarcinoma/*diagnosis/pathology
Cholangiopancreatography, Magnetic Resonance
Choledochostomy
Endoscopy, Gastrointestinal
Female
Hemobilia/*diagnosis
Humans

Figure

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  Fig. 1. Esophagogastroduodenoscopy revealed (A) a blood clots protruding from choledochoduodenostomy site, (B) normal Ampulla of Vater, (C) no abnormal lesion in intrahepatic bile duct and (D) a ulcerative mass in the distal common bile duct.

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  Fig. 2. Magnetic resonance chol-angiopancreatography revealed (A) choledochoduodenostomy site at perihilar area (arrow) and (B) ec-centric narrowing of distal common bile duct due to a mass (arrow head).

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  Fig. 3. Pathologic examination of the ulcerative mass in distal common bile duct revealed the irregular glandular structures with tumor cells, compatible with those of cholangiocarcinoma. (H&E, ×200).

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