Cystic duct carcinoma manifesting as hemobilia

Abstract

We experienced a case of cystic duct carcinoma manifesting as hemobilia. A 77-year-old man visited our hospital because of upper abdominal pain. His hepatobiliary enzymes were elevated and a high density object in the choledochus and cystic duct was observed on plain CT; therefore, we diagnosed him with choledochus and cystic duct calculi. As he was taking two antithrombotic drugs, we placed a biliary stent during the first ERC. Upon re-examination after 5 days, no obvious calculi were found in the choledochus. However, as the cystic duct was not visualized, stones may have existed there. He was scheduled for surgery and discharged. The patient visited again with abdominal pain two months later. Plain CT revealed a high density substance in the choledochus, and we diagnosed hemobilia. On ERC, we saw bleeding from the biliary orifice and clots in the choledochus. A stained area in the cystic duct was observed on contrast enhanced CT. A diagnosis of adenocarcinoma was made by brushing cytology, and bile duct resection was performed. When patients undergoing antithrombotic therapy have liver dysfunction, we should consider the possibility of hemorrhage from hepatobiliary tumors.