Nontraumatic hemobilia: disparate episodes 7 years apart in the same patient.

A case is reported of nontraumatic hemobilia, which occurred twice in the same patient. Initially it was due to carcinoma of the gallbladder and 7 years later it was due to a ruptured intrahepatic aneurysm. The management of these two conditions is reviewed. The clinical marker of nontraumatic hemobilia originating in the gallbladder is the hemocholecyst and the treatment is cholecystectomy. Ruptured intrahepatic aneurysm can be diagnosed only by angiography. Cholangiography is indicated to rule out pathologic conditions of the ducts. In the absence of hepatobiliary sepsis selective hepatic artery ligation is the preferred treatment, otherwise hepatic resection is required.