Haemobilia in a patient on oral anticoagulation: A surgical case report

Haemobilia causing obstructive jaundice is a rare complication with most occurrences reported post instrumentation e.g. endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangioagraphy (PTC) and, trans-cystic duct exploration or due to hepatic tree pseudoaneurysms. Traumatic haemobilia typically presents with the classical triad of right upper quadrant pain, jaundice and upper gastrointestinal bleeding. On imaging, an obstructed biliary tree is commonly found dilated.

We report a case of a large obstructing blood clot causing biliary sepsis for a patient on oral anticoagulation. The patient had no classical triad findings or demonstrable evidence of biliary obstruction on imaging. The patient was managed with clot retrieval via ERCP and sphincterotomy; anticoagulant was resumed seven days post procedure.

Haemobilia is a rare consequence in patients on anticoagulation therapy. The management principles are coagulopathy correction and obstruction relief. The pathophysiology in patients without bleeding disorders remains unknown.

Although rare, haemobilia can be a cause of obstructive jaundice for a patient on anticoagulation.