Endoscopy Challenge #3 - May '10

Diagnosis

Diagnosis:

To evaluate melanotic stools and anemia, upper GI endoscopy revealed normal esophagus and stomach, but a pool of bile with evidence of fresh blood was seen in the duodenum. Exam with a side viewing scope (duodenoscope) revealed fresh blood draining from the major papilla see image.



Hemobilia secondary to liver biopsy was diagnosed, with ongoing bleeding likely due to thrombocytopenia. The patient eventually improved with time and platelet transfusions to maintain a level above 75,000.

History

Discussion

References