Cholangiocarcinoma presenting as hemobilia and recurrent iron-deficiency anemia: a case report

Saif S Ahmad,Andrew Douds,Rajarathnam Mathialagan,Faisal Tm Basheer,Saad F Idris,Radhakrishnan Hariraj

doi:10.1186/1752-1947-4-133

Abstract

IntroductionIron-deficiency anemia is a relatively common presenting feature of several gastrointestinal malignancies. However, cholangiocarcinoma has rarely been reported as an underlying cause. The association of cholangiocarcinoma with the rare clinical finding of hemobilia is also highly unusual. To our knowledge, this is the first case report of cholangiocarcinoma presenting with acute hemobilia and chronic iron-deficiency anemia.Case presentationWe report the case of a Caucasian, 84-year-old woman presenting with recurrent, severe iron-deficiency anemia who was eventually diagnosed with intra-hepatic cholangiocarcinoma, following an acute episode of hemobilia. A right hepatectomy was subsequently performed with curative intent, and our patient has now fully recovered.ConclusionThis is a rare example of hemobilia and chronic iron-deficiency anemia in association with cholangiocarcinoma. We suggest that a diagnosis of cholangiocarcinoma should be considered in patients who present with iron-deficiency anemia of unknown cause, particularly in the presence of abnormal liver function.

Highlights

Iron-deficiency anemia is a relatively common presenting feature of several gastrointestinal malignancies
Case presentation: We report the case of a Caucasian, 84-year-old woman presenting with recurrent, severe irondeficiency anemia who was eventually diagnosed with intra-hepatic cholangiocarcinoma, following an acute episode of hemobilia
This is a rare example of hemobilia and chronic iron-deficiency anemia in association with cholangiocarcinoma

Summary

Conclusion

This case illustrates two unusual presentations of intrahepatic cholangiocarcinoma: iron-deficiency anemia and hemobilia. That in the presence of recurrent iron-deficiency anemia, non-specific gastrointestinal symptoms and abnormal liver function, a diagnosis of cholangiocarcinoma is considered. This case serves to highlight the principle that the persistence of a symptom should be reflected in the persistence with which a clinician aims to establish a clear diagnosis. Authors' contributions SA wrote the initial manuscript, reviewed the patient notes and reviewed recent literature on hemobilia. SI reviewed literature on cholangiocarcinoma and assisted writing the manuscript. RH provided expert analysis of the case, RM assisted the literature review and AD fully reviewed the final submission. All authors read and reviewed the final manuscript. Competing interests The authors declare that they have no competing interests

Introduction

Findings

Discussion