One of the rarest sources of life-threatening hemorrhage from the upper gastrointestinal tract takes its origin from the biliary tract. The symptoms of right upper quadrant pain and jaundice, associated with massive, repeated, and exsanguinating gastrointestinal bleeding, with blood in the vomitus or in the stool, have been present in many of the reported cases. Although this triad is not constant, when present it should suggest the possibility of such a diagnosis.
The actual diagnosis can be proved only when profuse bleeding is seen coming from the ampulla of Vater, and is usually made after the usual causes of bleeding have been eliminated at the time of careful surgical exploration.
We have recently seen 2 such patients, both of whom had been operated upon previously and the source of their exsanguinating hemorrhage proved to be from the common duct. In spite of prior knowledge of the source of bleeding, these
GUYNN VL, REYNOLDS JT. Surgical Management of HemobiliaSpontaneous Hemobilia in Intrahepatic Origin. Arch Surg. 1961;83(1):73-80. doi:10.1001/archsurg.1961.01300130077009