title: Intermittent activity-induced hemobilia caused by liver hemangioma.
abstract: BACKGROUND
  Intestinal bleeding of unknown origin can lead to a difficult workup. Abdominal colic, melena/hematemesis, and jaundice represent the pathognomonic triad for hemobilia, but clinical presentation and etiology of this entity are varying. Seldom all of these symptoms are present, and rarely does hemobilia cause melena or hematemesis. Often the correct diagnosis is missed. Patients frequently have a long history of complaints and inadequate therapy.
  
  
  METHODS
  We report on a patient who complained of repeated, severe epigastric pain and massive melena induced by exercise activity. After 2 years of complaints and an unnecessary operation, ultrasound detected a liver hemangioma. It was supposed that the hemangioma was causing hemobilia during strenuous physical activity. The patient underwent a partial liver resection to eliminate the hemangioma. All complaints resolved, and the patient remained asymptomatic postoperatively.
  
  
  CONCLUSIONS
  Physicians should be aware of hemobilia as a rare cause of upper gastrointestinal bleeding, especially if esophagogastroduodenoscopy cannot demonstrate any bleeding source. Ultrasound is able to visualize many diseases leading to hemobilia and should be integrated into the early workup of unclear intestinal bleedings.
authors.affiliation: Department of Surgery, Medical University of Lübeck, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Birth
authors.forename: J
authors.initials: J
authors.lastname: Ortlepp
authors.forename: S
authors.initials: S
authors.lastname: Bontikous
authors.forename: M
authors.initials: M
authors.lastname: Amthor
authors.forename: H F
authors.initials: HF
authors.lastname: Weiser
authors.forename: H P
authors.initials: HP
authors.lastname: Bruch
mesh_terms: D000328:Adult; D005260:Female; D006392:Hemangioma, Cavernous / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006431:Hemobilia / Q000209:etiology*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D008551:Melena / Q000209:etiology; D014463:Ultrasonography