title: Hemobilia as the initial manifestation of cholangiocarcinoma in a hemophilia B patient.
abstract: 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.
authors.affiliation: Department of Gastroenterology, University of Thessaly, 16 Sklirou st, Larissa 41447, Greece.
authors.forename: Anastassios-C
authors.initials: AC
authors.lastname: Manolakis
authors.forename: Andreas-N
authors.initials: AN
authors.lastname: Kapsoritakis
authors.forename: Antonis-D
authors.initials: AD
authors.lastname: Tsikouras
authors.forename: Fotis-D
authors.initials: FD
authors.lastname: Tsiopoulos
authors.forename: Athanassios-K
authors.initials: AK
authors.lastname: Psychos
authors.forename: Spyros-P
authors.initials: SP
authors.lastname: Potamianos
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000175:diagnosis; D001653:Bile Ducts, Intrahepatic; D018395:CA-19-9 Antigen / Q000097:blood; D018281:Cholangiocarcinoma / Q000150:complications* / Q000175:diagnosis; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D006431:Hemobilia / Q000209:etiology*; D002836:Hemophilia B / Q000150:complications*; D006801:Humans; D008297:Male
chemical_list: D018395:CA-19-9 Antigen