Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3306
Peer-review started: November 24, 2021
First decision: December 26, 2021
Revised: December 29, 2021
Accepted: February 15, 2022
Article in press: February 15, 2022
Published online: April 6, 2022
Hemobilia occurs when there is a fistula between hepatic blood vessels and biliary radicles, and represents only a minority of upper gastrointestinal hemorrhages. Causes of hemobilia are varied, but liver abscess rarely causes hemobilia and only a few cases have been reported. Here, we present a case of atypical hemobilia caused by liver abscess that was successfully managed by endoscopic hepatobiliary intervention through endoscopic retrograde cholangiopancreatography (ERCP).
A 54-year-old man presented to our emergency department with a history of right upper quadrant abdominal colic and repeated fever for 6 d. Abdominal sonography and enhanced computed tomography revealed that there was an abscess in the right anterior lobe of the liver. During hospitalization, the patient developed upper gastrointestinal bleeding. Upper gastrointestinal endoscopy revealed a duodenal ulcer bleeding that was treated with three metal clamps. However, the hemodynamics was still unstable. Hence, upper gastrointestinal endoscopy was performed again and fresh blood was seen flowing from the ampulla of Vater. Selective angiography did not show any abnormality. An endoscopic nasobiliary drainage (ENBD) tube was inserted into the right anterior bile duct through ERCP, and subsequently cold saline containing (-)-nora
Hemobilia should be considered in the development of liver abscess, and endoscopy is essential for diagnosis and management of some cases.
Core Tip: Hemobilia occurs when there is a communication between intrahepatic blood vessels and biliary radicles caused by injury or some diseases, and represents only a minority of upper gastrointestinal hemorrhages. Liver abscess rarely causes hemobilia and only a few cases have been reported. Here, we present a rare case of atypical hemobilia caused by liver abscess that was successfully managed by catheter‐directed infusion of diluted (-)-noradrenaline with an endoscopic nasobiliary drainage tube.