[Hemobilia disclosing very small hepatocellular carcinoma ruptured into the biliary ducts]

In hepatocellular carcinoma, invasion of the biliary tree usually occurs in large tumors. We report a case of a minute hepatocellular carcinoma which invaded the biliary tree and was revealed by secondary hemobilia, in a 65-old alcoholic patient with cirrhosis. The tumour was not identified by preoperative morphological examinations. Surgical exploration was performed due to unexplained hemobilia. Tumoral debris were observed in the right intrahepatic biliary tract during operative choledoscopy, justifying a right hepatectomy. A 5 mm diameter tumour was found in liver specimen. No recurrence had occurred after 22 months. In conclusion, in cirrhotic patients, unexplained hemobilia can reveal a small, potentially curable, hepatocellular carcinoma which has spread to the biliary tree.