Hemorrhage into the biliary tract is an uncommon cause of hematemesis and/or melena. Even though uncommon, it should be considered in the differential diagnosis, especially when the source of bleeding cannot be demonstrated with certainty.
Sandblom8 has referred to bleeding into the biliary tract as hemobilia. The term seems appropriate and I believe it should be used to describe biliary tract bleeding regardless of the etiology.
Of the more than 100 cases of hemobilia reported in the literature, the great majority are caused by rupture of an atherosclerotic aneurysm of the right hepatic artery into the biliary duct system. McNair5 recently reviewed the world literature and found 12 instances in which ruptured right hepatic artery aneurysms causing hemobilia had been successfully treated.Sandblom8 has reported 9 cases of subcapsular liver injury that in most instances resulted in hemobilia.Quattlebaum6 has reported 2 cases in
GROVE WJ. Biliary Tract Hemorrhage as a Cause of Hematemesis. Arch Surg. 1961;83(1):67–72. doi:10.1001/archsurg.1961.01300130071008
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