Acute Pancreatitis and Cholangitis Caused by Hemobilia Secondary to Hepatocellualr Carcinoma: A Case Report

A 60-year-old female had the history of cirrhosis of liver, Child’s B, hepatitis B virus (HBV) related and hepatocellular carcinoma (HCC) [Tumor, Node, Metastasis (TNM) stage II, T2N0M0 and Barcelona Clinic Liver Cancer (BCLC) stage B post transcatheter arterial embolization (TAE) treatment]. She was sent to our hospital due to epigastric dull pain for 4 days and jaundice. Laboratory data disclosed elevations of pancreatic enzymes and total bilirubin level. Abdominal computerized tomography showed a tumor at segment 4 of liver (S4) with invasion of the common hepatic duct, which caused bilateral intrahepatic duct dilatation and extensive blood clots in the common bile duct, gallbladder and left intrahepatic duct. Mild pancreatic ductal dilatation was also noted. Acute pancreatitis and cholangitis related to hemobilia was considered. Due to poor liver function and high risk for TAE or surgery, the patient’s family decided to receive supportive care. Hepatocellular carcinoma with bile duct invasion and homobilia is rare. Hemobilia typically presents with a triad of jaundice, biliary colic and gastrointestinal bleeding. Blood clot in biliary tract can cause cholecystitis and cholangitis. In addition, pancreatitis may also happen when blood clot enters the pancreatic duct incidentally. TAE is the recommended treatment for hemobilia. On the other hand, hepatectomy is not feasible for patients with advanced tumor of liver. (J Intern Med Taiwan 2013; 24: 500-504)