Abstract
A 64-year-old man, a hepatitis B carrier, was admitted because of epigastric pain, bilirubinuria, pruritus, and acholic stools of 10 days' duration. Hepatocellular carcinoma had been diagnosed 3 years earlier and the patient had undergone 1 session of transhepatic artery embolization therapy. Laboratory data included the following: hemoglobin 9.1 gm/dL (normal: 13.5-18 gm/dL), alkaline phosphatase 1078 U/L (66-240 U/L), total bilirubin 4.57 mg/dL (0.2-1.0 mg/dL), serum amylase 1291 U/L (25-160 U/L), and serum lipase 1625 U/L (23-300 U/L). Abdominal CT demonstrated the hepatic tumor with retained lipiodol (A). ERCP showed blood clots draining from the major duodenal papilla (B), and cholangiography disclosed filling defects throughout the biliary ducts (C). Intraductal US revealed numerous heterogeneous echogenic filling defects; the wall of the duct was intact (D). An endoscopic sphincterotomy was performed and the clots were removed to the maximum possible extent. A nasobiliary drainage tube was placed to maintain luminal patency. The hemobilia resolved after selective hepatic artery tumor embolization, and the patient was discharged improved after 20 days in hospital.
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