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August 1967

An Unusual Case of Hemobilia: Hepatic Tuberculosis With Hemorrhage

Author Affiliations

From the Sunny Acres Cuyahoga County Tuberculosis Hospital (affiliated with the School of Medicine, Western Reserve University, Cleveland).

Arch Surg. 1967;95(2):202-206. doi:10.1001/archsurg.1967.01330140040010

BILIARY tract hemorrhage was first reported in 1892 by Naunyn1,2 who described three cases of ruptured aneurysm of the hepatic or cystic artery associated with gall stones or cholecystitis. Most cases of hemobilia are diagnosed at surgery or postmortem examination. Clinically, they present themselves as mild to severe, gastrointestinal hemorrhage. Most authorities agree that 95% of massive upper gastrointestinal hemorrhages can be accounted for etiologically on the basis of gastrointestinal ulceration, esophageal varices, gastritis, malignancies of the esophagus or stomach, and bleeding from a hiatus hernia. The remaining 5% of cases still constitute a constant challenge to the clinician. The biliary tract is rarely considered in such a differential diagnosis. In 1950, biliary tract hemorrhage and its causes were classified by Kerr et al3 in the following manner (Table). In 1964, Shohl4 presented the same classification with slight modification and substituted "hepatic necrosis following infection or

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