Biliary Tract Hemorrhage as a Cause of Hematemesis

Hemorrhage into the biliary tract is an uncommon cause of hematemesis and/or melena. Even though uncommon, it should be considered in the differential diagnosis, especially when the source of bleeding cannot be demonstrated with certainty. Sandblom⁸has referred to bleeding into the biliary tract as hemobilia. The term seems appropriate and I believe it should be used to describe biliary tract bleeding regardless of the etiology. Historical Review Of the more than 100 cases of hemobilia reported in the literature, the great majority are caused by rupture of an atherosclerotic aneurysm of the right hepatic artery into the biliary duct system. McNair⁵recently reviewed the world literature and found 12 instances in which ruptured right hepatic artery aneurysms causing hemobilia had been successfully treated. Sandblom⁸has reported 9 cases of subcapsular liver injury that in most instances resulted in hemobilia. Quattlebaum⁶has reported 2 cases in