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Published on: June 18, 2020
Intermittent activity-induced hemobilia caused by liver hemangioma
M Birth1, J Ortlepp, S Bontikous
1Department of Surgery, Medical University of Lübeck, Germany.
Digestive Surgery
|June 27, 2000
Summary
This case study highlights hemobilia, a rare cause of upper gastrointestinal bleeding, often missed in diagnosis. Early ultrasound is crucial for identifying conditions like liver hemangioma that can cause this bleeding.
Area of Science:
- Gastroenterology
- Hepatology
- Diagnostic Imaging
Background:
- Intestinal bleeding of unknown origin presents diagnostic challenges.
- Hemobilia, though rare, can manifest with varied symptoms, often leading to missed diagnoses and prolonged patient suffering.
- The classic triad for hemobilia (abdominal colic, melena/hematemesis, jaundice) is infrequently observed in its entirety.
Observation:
- A patient presented with recurrent severe epigastric pain and massive melena triggered by exercise.
- Despite a two-year history and an unnecessary surgery, the underlying cause remained elusive until ultrasound revealed a liver hemangioma.
- The hemangioma was suspected as the etiology of exercise-induced hemobilia.
Findings:
- Surgical resection of the liver hemangioma successfully resolved the patient's symptoms.
- The patient experienced complete symptom resolution and remained asymptomatic post-operation.
- This case underscores the link between liver hemangiomas and exercise-induced hemobilia.
Implications:
- Physicians should consider hemobilia in cases of obscure upper gastrointestinal bleeding, particularly when esophagogastroduodenoscopy is inconclusive.
- Ultrasound is a valuable tool for diagnosing conditions leading to hemobilia and should be incorporated early in the diagnostic workup.
- Awareness of hemobilia's varied presentations is essential for timely and accurate diagnosis.
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