2025 Volume 45 Issue 5 Pages 498-502
The patient, a 100-year-old woman who was under medical treatment for chronic heart failure, pulmonary thromboembolism and asthma, was brought to our hospital with the complaint of vomiting dark red blood. Upper gastrointestinal endoscopy (EGD) failed to identify the source of the bleeding, and the patient was treated conservatively. After the patient was placed on anticoagulant therapy and allowed to resume a normal diet, the patient again vomited a large amount of dark red blood and went into shock. A repeat EGD was performed, but the source of the bleeding could not be identified. During treatment (fasting and fluids), the patient again vomited dark red blood. Contrast-enhanced CT showed an aneurysm of the right hepatic artery that had perforated into the gallbladder, which was thought to be the source of the hemorrhage. After explaining the perioperative risks to the patient, we performed surgery; we ligated the anterior segment of the right hepatic artery at the root and resected the aneurysm and the gallbladder. Subsequently, the patient was discharged from the hospital without any recurrence of the bleeding. The diagnosis was difficult to make in this patient because she had no abdominal symptoms, elevated liver enzymes, or bleeding from the papillary region on EGD, and biliary hemorrhage could not be suspected at an early stage. Thus, biliary hemorrhage should be considered in the differential diagnosis of patients with repeated upper gastrointestinal bleeding in whom the source of bleeding cannot be identified.
