Hemobilia is a rare but important cause of gastrointestinal bleeding defined as the presence of blood within the biliary tract. The most common causes of hemobilia are hepatobiliary procedural interventions, trauma, and malignancy. The case herein presents a rare example of hemobilia in a patient with recurrent gastric adenocarcinoma metastatic to the biliary tree and rendezvous endoscopic retrograde cholangiopancreatography (ERCP) and highlights the importance of rapid diagnosis and tailored management. A 50-year-old man with history of gastric adenocarcinoma status-post Biliroth II reconstruction now with recurrent adenocarcinoma presented emergently with hematemesis and hematochezia two days after starting palliative chemotherapy. Cancer recurrence had been diagnosed 1-month prior when the patient was hospitalized for workup of new-onset abdominalgia, anorexia, and bilirubin of 19.0 mg/dL; during that hospitalization, magnetic resonance cholangiopancreatography (MRCP) demonstrated a long hilar stricture, and endcap-outfitted, colonoscope assisted ERCP revealed gastrojejunal anastomotic tumor and a 1.5 cm biliary stricture, the latter treated with dilation and placement of a fully-covered self-expanding metallic stent (fcSEMS) (a). Upon bleeding presentation, laboratory values revealed hemoglobin 5.5 g/dL, bilirubin 4.8 mg/dL, and mildly elevated liver enzymes; hours later, serum liver tests doubled, the patient developed chills, and blood cultures ultimately grew Klebsiella. Contrastenhanced computed tomography of the abdomen (b) revealed amorphous hyperdense material proximal to and within the fcSEMS suspicious for blood clot. Endoscopy showed clot in the stomach, no evidence of anastomotic bleeding, and clot emanating from and occluding the fcSEMS (c). Collectively, these were consistent with hemobilia. Interventional radiology was consulted, and a bleeding right hepatic arterial ramus was embolized. Bleeding ceased, liver tests improved, and the patient was discharged home with oncology follow-up. Hemobilia classically presents with Quincke's triad of hemorrhage, abdominalgia, and jaundice. In our patient, hemobilia was likely due to friable malignant tissue coupled with recent biliary intervention. Hemobilia requires a high index of suspicion for prompt diagnosis and treatment. Mild cases may be managed supportively and resolve spontaneously, while others often require treatment via interventional radiologic techniques.1287_A.tif Figure 1: ERCP revealing anastomotic tumor and a 1.5 cm biliary stricture treated with dilation and metallic stenting1287_B.tif Figure 2: Contrast-enhanced computed tomography revealed hyperdense material proximal to and within the stent.1287_C.tif Figure 3: Endoscopy showed clot occluding the metallic biliary stent