Open AccessHemobilia as the initial manifestation of cholangiocarcinoma in a hemophilia B patient
Author(s) -
Anastassios C. Manolakis,
Andreas Kapsoritakis,
Antonis D Tsikouras,
F. Tsiopoulos,
Athanassios K. Psychos,
Spyros Potamianos
Publication year - 2008
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.14.4241
Subject(s) - medicine , coagulopathy , malignancy , cancer antigen , haemophilia , haemophilia b , work up , surgery , cancer , haemophilia a
Hemobilia is a rare manifestation of hemophilia and is usually iatrogenic following liver biopsy. There are only few reports of spontaneous hemobilia in hemophilia patients. Cholangiocarcinoma is a well-established cause of hemobilia. We describe a case of a 70-year-old male, with known haemophilia B and a past history of papillotomy, who presented with classical symptoms of hemobilia. The initial diagnostic work-up failed to demonstrate a potential cause of bleeding other than the coagulopathy. Three months later, he was readmitted to our hospital with a second episode of hemobilia. During the second work-up, a cholangiocarcinoma was diagnosed both by imaging studies and by a significant elevation of cancer antigen 19-9. Although hemobilia could be attributed to hemophilia, especially in a patient with previous papillotomy, an underlying malignancy of the biliary tree should be suspected.