Hemobilia after liver biopsy. Early detection in a patient with mild hemophilia A.

Hemobilia occurred following liver biopsy in a patient with mild hemophilia A, despite adequate factor VIII transfusion. Before major hemorrhage occurred, the diagnosis of hemobilia was confirmed by endoscopy and retrograde cholangiography. Two aneurysms of the hepatic artery were found in the corresponding area of puncture injury. Surgical intervention was necessary for hydrops of the gallbladder with cholecystitis caused by blood clots occluding the cystic duct. The bleeding stopped spontaneously. Early endoscopy and retrograde cholangiography are beneficial in elucidating the exact cause and relationship of clinical signs and symptoms.