Warfarin therapy complicated by recurrent hemobilia in a patient with sarcoidosis

Haemobilia

“…Angiodysplasia 164 , arteriovenous malformation 88 and haemangioma are less common causes of signi®cant haemobilia 165 . Patients with underlying coagulopathy are more susceptible although this may be treated by correction of the diathesis and adequate drainage 11,18,49,63 . Vasculitis has been reported to cause signi®cant haemobilia, and may be associated with other connective tissue diseases 59 .…”

Nontraumatic Hemobilia in Children

“…The most commonly reported causes of nontraumatic hemobilia in children are infection (liver abscess, 3 4 parasitic infestation [ascariasis], 5 6 anatomical abnormalities [gastric duplication 7 ], biliary pathology [papillomatosis of the gallbladder, 8 gallbladder polyps 9 ) and bleeding disorders (von Willebrand disease). 10 Other documented nontraumatic causes that have been described in adults include tumors (malignant 11 12 or benign 13 ), systemic lupus erythematosus, 14 sarcoidosis, 15 biliary pathology (cholelithiasis, cholecystitis, choledochal cyst, 16 gallbladder ulcer 17 ), pancreatitis, and warfarin therapy ( Table 1 ).…”

Massive hemobilia in childhood

“…They are an uncommon condition associated with chronic abdominal pain, but should be considered in a child with a mass in the portal triad and biliary obstruction. The classic combination of right upper abdominal pain, jaundice, and gastrointestinal bleeding is pathognomonic of hemobilia; however, it has been reported in only 22% of adult patients [1][2][3][4][7][8][9][10][11][12][13][14][15][16][17][18][19][20] . Nontraumatic hemobilia is rare in children, and many patients do not present with the classic triad symptoms of biliary colic, obstructive jaundice, and intestinal bleeding [3,6] .…”

“…Massive hemobilia may present as an acute, life-threatening hemorrhage, even in the subset of nontraumatic hemobilia. It has been suggested that hemobilia should be part of the differential diagnosis for patients with other hepatobiliary diseases who present with a gastrointestinal bleed [2,7,18] . When hemobilia is suspected in a child, a complete parasitic screen should be performed.…”

“…The most common causes of nontraumatic hemobilia in children are infections, such as a liver abscess; multiple aneurysms due to parasitic infestation; vascular malformations; anatomical abnormalities, like gastric ectopia and duplication; biliary pathology, such as papillomatosis and polyps of the gallbladder; and bleeding disorders, like von Willebrand disease [7][8][9][10][11][12][13] . Other documented nontraumatic causes that have been described in adults include malignant or benign tumors, systemic lupus erythematosus, sarcoidosis, cholelithiasis, cholecystitis, choledochal cyst, gallbladder ulcer, pancreatitis, and warfarin therapy [14][15][16][17][18][19][20] . Nontraumatic hemobilia associated with cholecystitis is very rare.…”