Hemobilia is a term used to describe bleeding into the biliary tract. Most cases of hemobilia are diagn osed at surgery of postmortem examination.
Clinically, they presents themselves as mild to severe gastrintestinal hemorrhage.
The literature now has many case reports most often describing blunt trauma to the liver as a cause of hemobilia. Among the various causes of hemobilia, gallstone constitute the most rare one of causes.
This paper is to report a rare case of hemobilia associated with gallstone and reemphasize consideration of the biliary tract as a rare but real source of upper gastrointestinal hemorrhage.
A 38 year old male was admitted to the department of internal medicine on Jan, 26. 1968 because of marked right upper quadrant pain, nausea, vomiting and chilling for several days duration. He had had intermittent RUQ pain and tendernese which was radiated to back and right shoulder during this several years. On physical examination, markedly distended gallbladder was palpable on RUQ area. Blood chemistry showed markedly elevated value of alkaline phsphatase (15B Unit). GB series showed nonfunctioning gallbladder. Just prior to operation, he had hematemesis of small amounts and vomited up ascaris.
Under the diagnosis of GB empyema, operation was performed and showed that all biliary tract was full of old blood clots mixed with fresh blood about 200 cc in amounts.
Chestnut sized single bilirubin stone was found in the gallbladder. Common duct showed marked dilatation, 1.5cm in diameter and contains adult ascaris.
After cholecystectomy and choledochostomy with T-tube drainage, patient was recovered well without complication. Postoperative T-tube cholangiogram showed no abnormality.
The patient was discharged on 14th hospital day uneventfully.
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