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July 1961

Surgical Management of Hemobilia: Spontaneous Hemobilia in Intrahepatic Origin

Author Affiliations

From the Department of Surgery, Presbyterian-St. Luke's Hospital, and the University of Illinois College of Medicine.

Arch Surg. 1961;83(1):73-80. doi:10.1001/archsurg.1961.01300130077009

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