Hemobilia is a
hemorrhage into the biliary tract that may follow surgical
trauma, liver biopsy,
aneurysms, extra- or intra-hepatic
tumors of the biliary tract,
gallstones, and inflammatory lesion of liver, especially helminthic or pyogenic. Sometimes, it is associated with primary
liver cancer. An 84 year-old woman was admitted because of continuous right upper quadrant
pain 4 days before admission. Physical examination revealed decreased skin turgor, icteric sclerae and severe tenderness on right upper quadrant abdomen. She had no hepatosplenomegaly, and no rebound tenderness. She has been taking
warfarin for 3 weeks before admission because of
atrial fibrillation. On admission, serum
bilirubin and
transaminase were elevated. The level of
hemoglobin and hematocrit were 11.3 g/dL and 37.4%, respectively.
HBsAg was negative, but
IgG anti-HBc and anti-HBs were positive and anti-HCV was negative. Parasite skin test and stool ova count demonstrated non-specific findings. Stool occult blood was strongly positive, and prothrombin time was markedly prolonged. According to endoscopic retrograde cholangiopancreatography, common bile duct was dilated, and filled with
blood clot but there was no stone in bile tree. After two weeks, serum
transaminase,
bilirubin,
hemoglobin, hematocrit, and CA19-9 were normalized. We report a case of
hemobilia, occurring in a patient with continuous
warfarin use.