BLEEDING into the biliary tree, or hemobilia, is an unusual source of gastrointestinal hemorrhage. A large majority of these cases are posttraumatic, as in handlebar injuries, with about half occurring in children and teenagers.1 Up to two months after such injury, a triad of jaundice, melena, and colicky pain should lead to the diagnosis and cure. A tremendous amount of blood can enter the gastrointestinal tract from the liver via the common bile duct. Hemobilia may also follow several diseases of the biliary tract or liver such as cholelithiasis, aneurysms of the right hepatic artery, hepatic necrosis due to infection or toxins, erosion or rupture of malignant tumors or hemangiomata, and hepatic apoplexy following occlusion of the hepatic artery.2 The feature common to all is injury to a portion of the liver or biliary tree intimately associated with its blood supply.
One rare cause is hepatic necrosis associated