A Rare Cause of Massive Upper Gastrointestinal Bleeding.

Massive hemobilia is a rare complication of liver abscess. A 48-year-old male presented with massive hemobilia due to liver abscess. He had been complaining of right upper quadrant abdominal pain, fever, and jaundice for 10 days. This was followed by hematemesis and melena prior to emergency presentation. Upper gastrointestinal endoscopy showed fresh blood and clots coming from the orifice of the ampulla of Vater. The CT showed multiple liver abscesses, the largest one in the right lobe. Selective angiography revealed bleeding from a branch of the right hepatic artery into the biliary radicles. The bleeding was controlled by coil embolization. Drainage of the large liver abscesses was achieved under ultrasound guidance. Diagnostic modalities and management of hemobilia are discussed along with a review of the literature. A high index of suspicion, and the use of appropriate diagnostic tools can help diagnose and treat this rare cause of upper gastrointestinal bleeding.