Recurrent hemobilia secondary to extrahepatic biliary tract cholangiocarcinoma. A diagnostic challenge

• Published in: Revista española de enfermedades digestivas Vol. 116; no. 7; p. 391
• Main Authors: Díaz Molina, Raúl José, Fernández García, Joaquín, Khorrami Minaei, Sam, Martínez Ortega, Marco Antonio, Garrido Durán, Carmen
• Format: Journal Article
• Language: English; Spanish
• Published: Spain Sociedad Espanola de Patologia Digestivas 01.07.2024
• Subjects: Aged; Bile Duct Neoplasms - complications; Bile Duct Neoplasms - diagnosis; Bile Ducts, Extrahepatic - diagnostic imaging; Cholangiocarcinoma - complications; Cholangiocarcinoma - diagnosis; Diagnosis; Endoscopy, Digestive System; Female; Hemobilia - diagnostic imaging; Hemobilia - etiology; Humans; Hypertension; Recurrence
• ISSN: 1130-0108
• DOI: 10.17235/reed.2023.9922/2023

The etiology of hemobilia has mainly iatrogenic (>50%), followed by traumatic causes. Others are biliopathy due to portal high pressure, or neoplastic or infective biliopathy. In the case of non-clear hemobilia, direct-vision-cholangioscopy can change the management in >34% of cases. Our patient had episodes of obstructive hemobilia with secondary cholangitis without objectifying underlying pathology. When she was referred to our center, SpyGlass®-cholangioscopy identified the suspicious lesion compatible with early-stage cholangiocarcinoma despite the diagnostic delay. In conclusion, it is important to keep in mind the neoformative etiology as a potential cause of hemobilia of unclear origin, in which case, cholangioscopy (SpyGlass®) can contribute to the recognition of the signs of malignancy of the lesion and, therefore, to the diagnosis.