Arteriobiliary Fistula and Post-traumatic Pseudoaneurysm in the Right Hepatic Artery

Hemobilia is a rare but potentially life-threatening cause of upper gastrointestinal bleeding, defined as hemorrhage into the biliary tree resulting from an abnormal communication between the hepatic vasculature and the biliary system. It is most commonly associated with hepatobiliary surgical interventions and vascular injuries. We report the case of a female in her 20s with no relevant medical history, who underwent an apparently uncomplicated laparoscopic cholecystectomy in September 2023 and subsequently presented in February 2024 with recurrent, intermittent episodes of hematemesis and hematochezia. Upper gastrointestinal endoscopy demonstrated active hemobilia. Contrast-enhanced computed tomography revealed intrahepatic bile duct dilatation, pneumobilia, and a right hepatic artery pseudoaneurysm, establishing the diagnosis. The patient rapidly deteriorated, developing hemorrhagic shock and severe anemia, needing intensive care admission, endotracheal intubation, blood transfusion, and hemodynamic support. Definitive management was achieved through endovascular intervention with a stent, which remains the treatment of choice. This case highlights that hemobilia may present months after a cholecystectomy, often with intermittent or subtle bleeding, underscoring the importance of maintaining a high index of suspicion and recognizing this rare but serious complication early to prevent morbidity and mortality.