Hemobilia.

Hemobilia is a relatively rare manifestation of hepatobiliary disease that is usually characterized by recurrent colicky upper abdominal pain, gastrointestinal bleeding, and obstructive jaundice. In most instances, hemobilia presents as complication of liver injury, blunt abdominal trauma, or liver surgery. Other causes are percutaneous diagnostic procedures, hepatic artery aneurysms, inflammatory disease, biliary tract stones, and liver and bile duct neoplasms. The diagnosis of hemobilia is confirmed by endoscopy and selective angiography. Treatment of hemobilia is primarily surgical, with direct exploration of the liver, ligation of the bleeding point, and relief of bile duct obstruction. If liver damage is minimal, nonoperative management may be successful but requires careful observation and serial arteriography.