A 72-year-old man, with a history of proton beam therapy, transcatheter arterial chemoembolization (TACE), and radiofrequency ablation for hepatocellular carcinoma (HCC), presented to the emergency department of a hospital with abdominal pain and jaundice. Contrast-enhanced computed tomography revealed dilated intrahepatic bile ducts and hyperdense contents in the common bile duct. Endoscopic retrograde cholangiopancreatography (ERCP) revealed hemobilia, although the source of bleeding could not be detected because of multiple blood clots. He was referred to our hospital, and we performed contrast-enhanced magnetic resonance imaging and angiography. However, we could not identify the bleeding source; therefore, he was followed up. Four months later, he was readmitted to our hospital for abdominal pain. A second ERCP was performed, which revealed a filling defect in the left hepatic duct. Peroral cholangioscopy showed a polypoid lesion in the left hepatic duct, which bled easily on contact. The mass was considered to be the cause of hemobilia. Biopsy was performed, and the pathological analysis led to the diagnosis of a bile duct tumor thrombus of HCC. He underwent TACE, and recovered without recurrence of hemobilia.
