hemobilia of hepatic arterial pseudoaneurysm as a rare complication of chronic cholangitis

Hemobilia is a rare cause of obscure gastrointestinal hemorrhage, often resulting from iatrogenic or traumatic events. however, hemobilia caused by a hepatic artery pseudoaneurysm secondary to ascending cholangitis is particularly uncommon and poses significant diagnostic and therapeutic challenges. we present the case of an 81-year-old female with a history of chronic cholangitis and five prior choledocholithotomies who was admitted with right upper quadrant pain. initial abdominal ultrasound suggested biliary stones with cholangitis. on day 7 of admission, the patient developed acute gastrointestinal bleeding. subsequent computed tomography (ct) and magnetic resonance imaging (mri) revealed hemobilia and a ruptured intrahepatic artery pseudoaneurysm. the pseudoaneurysm was successfully treated with coil embolization, followed by endoscopic retrograde cholangiopancreatography (ercp) with endoscopic nasobiliary drainage to remove blood clots from the common bile duct. the clinical status of the patient was significantly improved following intervention. this case highlights the importance of early diagnosis and multidisciplinary management in cases of hemobilia secondary to hepatic artery pseudoaneurysms, particularly in patients with a history of chronic biliary disease. liekwise, the underlying mechanisms were discussed and the relevant literature was reviewed.