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Case Reports
. 2025 Feb:127:110853.
doi: 10.1016/j.ijscr.2025.110853. Epub 2025 Jan 6.

Haemobilia in a patient on oral anticoagulation: A surgical case report

Iman Hameed  1 , Yahya Al-Habbal  2
Affiliations
Case Reports

Haemobilia in a patient on oral anticoagulation: A surgical case report

Iman Hameed et al. Int J Surg Case Rep. 2025 Feb.

Abstract

Introduction: Haemobilia causing obstructive jaundice is a rare complication with most occurrences reported post instrumentation e.g. endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangioagraphy (PTC) and, trans-cystic duct exploration or due to hepatic tree pseudoaneurysms. Traumatic haemobilia typically presents with the classical triad of right upper quadrant pain, jaundice and upper gastrointestinal bleeding. On imaging, an obstructed biliary tree is commonly found dilated.

Case presentation: We report a case of a large obstructing blood clot causing biliary sepsis for a patient on oral anticoagulation. The patient had no classical triad findings or demonstrable evidence of biliary obstruction on imaging. The patient was managed with clot retrieval via ERCP and sphincterotomy; anticoagulant was resumed seven days post procedure.

Discussion: Haemobilia is a rare consequence in patients on anticoagulation therapy. The management principles are coagulopathy correction and obstruction relief. The pathophysiology in patients without bleeding disorders remains unknown.

Conclusion: Although rare, haemobilia can be a cause of obstructive jaundice for a patient on anticoagulation.

Keywords: Anticoagulation; Biliary imaging; Case report; ERCP; Haemobilia.

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Conflict of interest statement

Conflict of interest statement There were no conflicts of interest in the production of this article.

Figures

Fig. 1
Fig. 1
Axial section on Computed Tomography of Abdomen Pelvis (CTAP) showing cholelithiasis, peri-cholecystic oedema (A) and common bile duct diameter (B).
Fig. 2
Fig. 2
Initial ultrasound demonstrating non dilated proximal common bile duct. Limited view due to patient's body habitus.
Fig. 3
Fig. 3
Endoscopic Retrograde Cholangiopancreatography (ERCP) image demonstrating clot at orifice pre-sphincterotomy.
Fig. 4
Fig. 4
Intraoperative Cholangiogram (IOC) demonstrating dilated common bile duct.
See this image and copyright information in PMC

References

    1. Sohrabi C., Mathew G., Maria N., Kerwan A., Franchi T., Agha R.A. The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int. J. Surg. 2023;109(5):1136–1140. - PMC - PubMed
    1. Agha R.A., Fowler A.J., Rajmohan S., Barai I., Orgill D.P., Afifi R., et al. Preferred reporting of case series in surgery; the PROCESS guidelines. Int. J. Surg. 2016;36:319–323. - PubMed
    1. Schonberger R.B., Haddadin A.S. The anesthesia patient with acute coronary syndrome. Anesthesiol. Clin. 2010;28(1):55–66. - PubMed
    1. Berry R., Han J.Y., Kardashian A.A., LaRusso N.F., Tabibian J.H. Hemobilia: etiology, diagnosis, and treatment(☆) Liver Res. 2018;2(4):200–208. - PMC - PubMed
    1. Manolakis A.C., Kapsoritakis A.N., Tsikouras A.D., Tsiopoulos F.D., Psychos A.K., Potamianos S.P. Hemobilia as the initial manifestation of cholangiocarcinoma in a hemophilia B patient. World J. Gastroenterol. 2008;14(26):4241–4244. - PMC - PubMed

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