[A case of non-traumatic hemobilia due to warfarin therapy].
Hemobilia is a hemorrhage into the biliary tract that may follow surgical trauma, liver biopsy, aneurysms, extra- or intra-hepatic tumors of the biliary tract, gallstones, and inflammatory lesion of liver, especially helminthic or pyogenic. Sometimes, it is associated with primary liver cancer. An 84 year-old woman was admitted because of continuous right upper quadrant pain 4 days before admission. Physical examination revealed decreased skin turgor, icteric sclerae and severe tenderness on right upper quadrant abdomen. She had no hepatosplenomegaly, and no rebound tenderness. She has been taking warfarin for 3 weeks before admission because of atrial fibrillation. On admission, serum bilirubin and transaminase were elevated. The level of hemoglobin and hematocrit were 11.3 g/dL and 37.4%, respectively. HBsAg was negative, but IgG anti-HBc and anti-HBs were positive and anti-HCV was negative. Parasite skin test and stool ova count demonstrated non-specific findings. Stool occult blood was strongly positive, and prothrombin time was markedly prolonged. According to endoscopic retrograde cholangiopancreatography, common bile duct was dilated, and filled with blood clot but there was no stone in bile tree. After two weeks, serum transaminase, bilirubin, hemoglobin, hematocrit, and CA19-9 were normalized. We report a case of hemobilia, occurring in a patient with continuous warfarin use.
Hong
Jong Wook
JW
Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea.
Han
Yo Seb
YS
Lee
Jong Hoo
JH
Kim
Nam Hoon
NH
Lim
Keun Woo
KW
Joung
Yong Hee
YH
Dong
Seok Ho
SH
Kim
Hyo Jong
HJ
Kim
Byung Ho
BH
Chang
Young Woon
YW
Lee
Joung Il
JI
Chang
Rin
R
Hong
Sung Wha
SW
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006431:Hemobilia / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D014859:Warfarin / Q000009:adverse effects*
D000925:Anticoagulants; D014859:Warfarin