Hemobilia secondary to metastatic liver disease.

Hemobilia has previously been reported only in association with primary hepatic tumors. A patient with metastatic liver disease is described who presented with melena, abdominal pain, and jaundice. Bleeding from the ampullary papilla was observed at endoscopy. Jaundice resulted from biliary obstruction by blood clots containing foci of tumor cells identical to those of the hemorrhagic hepatic tumor nodules. Hemobilia from metastatic liver disease may occur more commonly than reported.