Qamar Zia, Farhan Majeed, Nasim Tarar, Sultan Muzaffar.
Hemobilia - a rare cause of hematemesis
Pak Armed Forces Med J Dec 2005;55(4):358-60.
Combined Military Hospital, Rawalpindi

A 14 years old boy was evacuated with 7 hours history of blunt abdominal trauma. He was hit in the epigastric region with a cricket bat. The initial symptom was pain at the affected site which progressively worsened and the boy started vomiting out, all what he ate. He was taken to a local doctor who prescribed analgesics and referral to a tertiary care hospital. At the time of presentation, he was restless, pale and his pulse was 120/min. FAST ultrasound revealed free fluid in the pelvis and mixed echogenic mass in the portahepatis. The boy was resuscitated in the trauma centre with intravenous fluids and blood transfusion. He was operated upon, through a midline laparotomy approach. Operative findings included haemoperitoneum, a 3 cm linear laceration in the diaphragmatic surface of the right lobe of liver and a laceration in the falciform ligament of the liver. Both the lacerations were repaired with Vicryl 1. Haemostasis was secured and abdominal cavity was washed with normal saline and wound closed with Prolene 1. After about 30 minutes of the operation, the boy had a massive attack of haematemesis. The blood was fresh and did not stop with washing of stomach with normal saline. A decision for re-exploration was made. Abdomen was opened through the previous wound. Operative findings: No blood in the stomach, No injury to the abdominal part of esophagus and Tense, dilated gall bladder. Aspiration revealed blood, mixed with bile. A diagnosis of Hemobilia was made.

Category: Case Reports
Keywords: Hemobilia. Hematemesis.

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