Hemobilia refers to the presence of blood in the biliary tree.

Clinical presentation

The classical clinical triad, only seen in ~50% of cases, consists of:

  • melena (i.e. upper gastrointestinal bleeding)
  • jaundice
  • abdominal pain
  • Pathology

    • iatrogenic: surgical or percutaneous procedures (~67%)
    • trauma (~5%)
    • vascular malformations (7%)
      • e.g. hepatic artery aneurysm or arteriovenous malformation
      • can cause massive hemobilia
    • malignancy (e.g. hepatocellular carcinoma - most common, gallbladder metastases)
    • abscess formation
    • gastrointestinal bleed due to gallstones

    Radiographic features


    Ultrasound is often the first investigation and reveals echogenic material in the bile ducts and dilated gallbladder.

    • high-attenuation clot within the bile ducts