Hemobilia: endoscopic diagnosis and association with pancreatitis

Hemorrhage into the biliary tract, known as hemobilia, is discussed almost exclusively in the surgical literature. Internists should also be aware of this entity. Two cases of hemobilia from hepatic artery aneurysm that ruptured into the biliary tract are presented. Both patients developed pancreatitis in addition to the classic symptom triad of melena, right upper quadrant pain, and jaundice. In one paitent, hemobilia was established by endoscopy. The authors adivse endoscopy workup of such patients and emphasize that pancreatitis, secondary to pancreatic duct obstruction, may be more common with hemobilia than has been reported.